Imagine your body has little workers inside called hormones. These hormones are like messengers telling different body parts what to do. The adrenal gland is an endocrine organ that is located above the kidneys and it produces various different hormones.
Adrenal insufficiency is when the adrenal glands can’t make enough of these important hormones. It’s like having a shortage of messengers, which can cause problems in your body.

What Is Adrenal Insufficiency?

Adrenal insufficiency is a rare but serious medical condition that occurs when the adrenal glands do not produce enough of certain hormones, primarily cortisol and sometimes aldosterone. These hormones are essential for various bodily functions and help the body respond to stress, regulate metabolism, control blood sugar levels, blood pressure levels and maintain fluid and electrolyte balance. Deficiency of cortisol can be life threatening if not replaced in time.

What Are the Causes of Adrenal Insufficiency?

Causes for adrenal deficiency typically fall into two main categories: primary adrenal insufficiency (Addison’s disease) and secondary adrenal insufficiency. Here’s a breakdown of the common causes for each:

Primary Adrenal Insufficiency (Addison's Disease)

Autoimmune Disorders – In many cases, the body’s immune system mistakenly attacks and damages the adrenal glands. This is the most common cause of Addison’s disease.
Infections – Certain infections, such as tuberculosis or fungal infections, can affect the adrenal glands and reduce their ability to produce hormones.
Cancer – Rarely, cancerous growths in the adrenal glands can disrupt hormone production.
Genetic Conditions – Some genetic disorders can lead to abnormal development or function of the adrenal glands, resulting in adrenal insufficiency.

Secondary Adrenal Insufficiency

Pituitary Gland Disorders – The pituitary gland in the brain produces a hormone called ACTH (adrenocorticotropic hormone), which stimulates the adrenal glands to produce cortisol. A problem with the pituitary gland, such as a tumour or damage, can lead to insufficient ACTH production and, consequently, lower cortisol levels.
Hypothalamus Dysfunction – The hypothalamus, also in the brain, produces a hormone called CRH (corticotropin-releasing hormone) that signals the pituitary gland to release ACTH. Any disruption in this process can lead to secondary adrenal insufficiency.
Prolonged use of Steroids – If someone has been taking steroids (such as for asthma, rheumatoid arthritis, or other conditions) for a long time, it can suppress the natural production of cortisol, causing adrenal deficiency. The adrenal gland will need to be supported with steroid replacement therapy during this period of time.

What Are Some Common Symptoms of Adrenal Insufficiency?

Adrenal insufficiency can cause a variety of symptoms that can range from mild to severe. The specific symptoms experienced can vary depending on the severity of the condition and whether it is primary or secondary adrenal insufficiency. Here are some common symptoms associated with adrenal insufficiency:

Fatigue and Weakness

Feeling excessively tired and lacking energy is a hallmark symptom of adrenal insufficiency. This fatigue can be persistent and may not improve with rest.

Weight Loss

Unintentional weight loss can occur due to altered metabolism and energy regulation.

Low Blood Pressure

Adrenal hormones play a role in regulating blood pressure. Insufficient hormone production can lead to low blood pressure, dizziness, or fainting upon standing.

Dizziness and Lightheadedness

These symptoms can be related to low blood pressure and reduced fluid and electrolyte balance.

Salt Cravings

Adrenal hormones help regulate sodium levels in the body. A deficiency can lead to cravings for salty foods.

Nausea and Vomiting

Digestive symptoms like nausea and vomiting can occur, especially during periods of stress.

Abdominal Pain

Pain or discomfort in the abdominal area may occur, often with a vague, nonspecific feeling.

Darkening of the Skin (Hyperpigmentation)

In primary adrenal insufficiency, a condition known as hyperpigmentation can cause the skin to darken, particularly in skin folds, creases, and scars.

Loss of Appetite

A reduced desire to eat can contribute to weight loss and fatigue.

Mood Changes

Irritability, depression, and mood swings are possible due to the impact of hormone imbalance on brain function.

Muscle and Joint Pain

Muscle weakness and joint pain can result from decreased hormone levels affecting muscle function.

Hair Loss

Hair thinning or loss can occur as a result of disrupted hormonal balance.

Irregular Menstrual Cycles

Women with adrenal insufficiency may experience irregular or absent menstrual periods.

Difficulty Handling Stress

Adrenal hormones help the body respond to stress. With adrenal insufficiency, the body may have difficulty responding effectively to physical or emotional stressors.

Adrenal Crisis

An adrenal crisis can occur in severe cases, characterised by extremely low blood pressure, confusion, rapid heart rate, and severe vomiting. This is a medical emergency requiring immediate attention.

How Is Adrenal Insufficiency Diagnosed?

Diagnosing adrenal insufficiency involves a combination of medical history, physical examination, and specialised tests. Because the symptoms of adrenal insufficiency can be nonspecific and resemble those of other conditions, a comprehensive evaluation is necessary to determine the underlying cause. Here’s an overview of the diagnostic process:

Medical History and Physical Examination

Your healthcare specialist will ask about your symptoms, medical history, and any medications you’re taking. They will also conduct a physical examination to look for signs of adrenal insufficiency, such as changes in skin pigmentation, blood pressure changes, and other relevant indicators.

Blood Tests

Blood tests are essential for measuring hormone levels in the blood. Commonly measured hormones include cortisol and sometimes aldosterone. Typically, blood samples are taken in the morning when cortisol levels are naturally higher.

ACTH Stimulation Test

This test assesses how well your adrenal glands respond to ACTH (adrenocorticotropic hormone), which normally stimulates the adrenal glands to produce cortisol. A baseline blood sample is taken, followed by an injection of synthetic ACTH. Additional blood samples are taken at specific intervals to measure cortisol levels. A blunted cortisol response indicates adrenal insufficiency.

Imaging Studies

Imaging tests, such as CT or MRI scans, may be ordered to examine the adrenal glands and rule out structural abnormalities, tumours, or infections.

Electrolyte and Blood Sugar Tests

Adrenal insufficiency can affect electrolyte and blood sugar balance. Tests may be performed to assess sodium, potassium, and blood glucose levels.

Insulin Tolerance Test (ITT)

This test is used to diagnose secondary adrenal insufficiency. It involves administering insulin to induce hypoglycemia and stimulate the release of cortisol. Blood samples are taken to monitor cortisol response.

Genetic Testing

In cases of suspected genetic causes of adrenal insufficiency, genetic testing may be recommended to identify specific mutations or abnormalities.

What Are the Health Complications of an Untreated Adrenal Insufficiency?

Untreated adrenal insufficiency can lead to a range of serious health complications, some of which can be life-threatening. It’s crucial to seek prompt medical attention and adhere to treatment if you are diagnosed with adrenal insufficiency. Here are some potential complications that can arise from untreated adrenal insufficiency:

Adrenal Crisis

This is a severe and life-threatening complication of adrenal insufficiency. It occurs when the body cannot cope with physical stress or illness due to extremely low cortisol levels. Symptoms of adrenal crisis include extremely low blood pressure, confusion, rapid heart rate, dehydration, vomiting, and even loss of consciousness. The adrenal crisis requires immediate medical treatment, typically involving intravenous corticosteroids and fluid replacement.

Electrolyte Imbalance

Adrenal hormones play a role in regulating electrolyte levels in the body, particularly sodium and potassium. Untreated adrenal insufficiency can lead to imbalances in these electrolytes, affecting heart function and other bodily processes.


Cortisol helps regulate blood sugar levels by promoting the release of glucose from the liver. In its absence, blood sugar levels can drop dangerously low, leading to hypoglycemia, which can cause confusion, dizziness, seizures, and loss of consciousness.

Cardiovascular Complications

Low blood pressure and electrolyte imbalances associated with untreated adrenal insufficiency can strain the cardiovascular system, potentially leading to heart rhythm abnormalities, fainting, and other heart-related issues.

Gastrointestinal Issues

Adrenal insufficiency can impact the digestive system, leading to nausea, vomiting, and abdominal pain. Untreated, these symptoms can contribute to dehydration and malnutrition.

Mood and Mental Health Changes

Hormone imbalances can affect mood, leading to irritability, anxiety, depression, and cognitive changes. These symptoms can worsen if adrenal insufficiency goes untreated.

Weakness and Fatigue

Persistent fatigue and weakness can interfere with daily activities and reduce overall quality of life.


The immune system may be compromised in people with untreated adrenal insufficiency, making them more susceptible to infections.

Skin Changes

Hyperpigmentation, or skin darkening, is a characteristic symptom of primary adrenal insufficiency. If left untreated, skin changes can become more pronounced.

Impaired Stress Response

Adrenal hormones help the body respond to physical and emotional stress. The body’s ability to manage stress is compromised without adequate hormone levels.

Lack of Growth and Development (in Children)

Adrenal insufficiency in children can impact growth and development if not treated promptly.

Fertility and Menstrual Irregularities

Untreated adrenal insufficiency can disrupt reproductive hormone balance, affecting fertility and causing irregular menstrual cycles.

What Are the Different Treatment Options for Adrenal Insufficiency?

Treating adrenal insufficiency involves replacing the deficient hormones to restore proper bodily functions and alleviate symptoms. The treatment approach depends on the underlying cause of adrenal insufficiency (primary or secondary) and the specific hormone deficiencies. Here are the main treatment options:

Hormone Replacement Therapy

  • Cortisol Replacement – The cornerstone of treatment is replacing cortisol, the primary stress hormone. Synthetic cortisol medications, such as hydrocortisone, prednisone, or dexamethasone, are prescribed to mimic the body’s natural cortisol production. Dosage is typically divided throughout the day to replicate the body’s natural cortisol rhythm.
  • Aldosterone Replacement – If aldosterone levels are also low (typically in primary adrenal insufficiency), a synthetic form of aldosterone or a medication that mimics its effects may be prescribed. This helps maintain electrolyte and fluid balance.

Stress Management and Dosing Adjustments

  • Individuals with adrenal insufficiency need to adjust their medication dosages during stress, illness, surgery, or other significant events requiring higher cortisol levels. Your healthcare specialist will guide when and how to adjust your medication.

Lifestyle and Self-Care

  • Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can help manage symptoms and overall well-being.
  • Carrying a medical alert bracelet or wearing an identification card is recommended to inform healthcare specialists about your condition in emergencies.

Regular Medical Checkups

  • Regular follow-up appointments with your healthcare specialist are essential to monitor hormone levels, adjust medication dosages as needed, and address concerns.

Education and Patient Empowerment

  • Understanding your condition, recognising hormone deficiency or excess symptoms, and knowing how to adjust medications during stress are important aspects of managing adrenal insufficiency

Crisis Prevention and Management

  • Individuals with adrenal insufficiency are educated on recognising the signs of an impending adrenal crisis and taking immediate action, which usually involves increasing medication dosages and seeking emergency medical care.

What Lifestyle Tips Can Help in Managing the Symptoms of Adrenal Insufficiency?

Lifestyle plays a crucial role in managing the symptoms of adrenal insufficiency and improving overall well-being. While medical treatment is essential, adopting certain lifestyle habits can help you better manage your condition and minimise potential complications. Here are some lifestyle tips to consider:

Consistent Medication Management

  • Adhere to your prescribed medication schedule and dosage to ensure a steady supply of hormones. Work closely with your healthcare specialist to adjust medications as needed.

Stress Management

  • Stress can exacerbate symptoms of adrenal insufficiency. Practice stress-reduction techniques such as deep breathing, meditation, yoga, progressive muscle relaxation, or mindfulness to help manage stress levels.

Regular Exercise

  • Engaging in regular, moderate exercise can help improve mood, energy levels, and overall health. Consult your healthcare specialist before starting a new exercise routine to ensure it’s appropriate for your condition.

Balanced Diet

  • Eat a balanced and nutritious diet rich in whole grains, lean proteins, fruits, vegetables, and healthy fats. Aim for regular, balanced meals to help stabilise blood sugar levels.


  • Stay adequately hydrated by drinking enough water throughout the day. Proper hydration supports overall bodily functions.

Salt Intake

  • If you have aldosterone deficiency (primary adrenal insufficiency), your healthcare specialist may recommend increasing your salt intake slightly to help maintain electrolyte balance. Follow your doctor’s advice on salt intake.

Get Enough Sleep

  • Prioritize quality sleep to support hormone balance and overall well-being. Establish a consistent sleep routine and create a comfortable sleep environment.

Avoid Overexertion

  • Listen to your body and avoid excessive physical or mental stress. Rest when needed, and don’t push yourself beyond your limits.

Regular Medical Checkups

  • Attend regular follow-up appointments with your healthcare specialist to monitor hormone levels and adjust treatment as necessary.

Emergency Preparedness

  • Educate yourself and your loved ones about the signs of adrenal crisis and the steps to take in an emergency. Carry a medical alert bracelet or identification card to inform healthcare specialists about your condition.

Patient Education

  • Understand the details of your condition, treatment plan, and how to manage symptoms effectively. Knowledge empowers you to take control of your health.

Support Network

  • Seek support from family, friends, or support groups for individuals with adrenal insufficiency. Having a supportive network can help you manage the emotional and practical aspects of living with the condition.

Dr. Cho Li Wei 朱丽薇医生

Consultant Endocrinologist
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