The adrenal glands are located on top of the kidneys and are responsible for making a number of important hormones. One adrenal hormone, called cortisol, helps modulate the body's response to stress. Other hormones regulate the body's salt and water balance. Adrenal insufficiency is the result of the adrenal glands not making enough of these hormones and is usually treated with hormone replacement therapy.
Types
As the National Institute of Diabetes and Digestive and Kidney Disorders (NIDDK) explains, there are two main types of adrenal insufficiency. Primary adrenal insufficiency is caused by the adrenal glands themselves not making enough adrenal hormones. Secondary adrenal insufficiency, on the other hand, is caused by the pituitary gland not making enough of a hormone called adrenocorticotropic hormone (ACTH), which causes the adrenal glands to not be stimulated to make adrenal hormones. Primary and secondary adrenal insufficiency are treated differently.
Symptoms
The "Journal of the American Medical Association" (JAMA) explains that adrenal insufficiency can cause patients to feel fatigued and tired and can also lead to dizziness, diarrhea, unexpected weight loss, a craving for salt, and joint and belly pain. Patients with primary adrenal insufficiency may also develop darkened skin as a result of hormonal changes that happen due to the body's unsuccessful attempts to stimulate the adrenal glands.
Diagnosis
Adrenal insufficiency is typically diagnosed using a cortisol test, which measures the blood levels of cortisol (a hormone produced by the adrenal glands). To effectively treat adrenal insufficiency, doctors have to determine if the problem is with the pituitary or the adrenal glands. As Lab Tests Online explains, an ACTH stimulation test allows physicians to determine if the patient is suffering from primary or secondary adrenal insufficiency. With an ACTH stimulation test, the patient's cortisol levels are measured before and after synthetic ACTH is administered. If the patient's cortisol levels do not rise in response to ACTH, the adrenal insufficiency is caused by a problem with the patient's adrenal glands. Secondary adrenal insufficiency can also be a result of the patient taking corticosteroids for some other health problem.
Treatment
If there is a distinct cause of adrenal insufficiency (such as corticosteroid use or a tumor), treatment focuses on correcting this underlying disorder. Otherwise, treatment of adrenal insufficiency typically involves hormone replacement therapy, which typically needs to be continued for the rest of the patient's life. The NIH Clinical Center explains that most patients need to take synthetic glucocorticoids (such as hydrocortisone, dexamethasone or prednisone) to replace the hormones that are not being produced by the adrenal glands. Patients may also need to take an additional medication called fludrocortisone to maintain the proper salt balance.
Complications
Most patients respond well to replacement doses of adrenal hormones to treat their condition. There are some cases, however, in which patients need extra doses of these replacement hormones. Emotional or physical stress, illnesses, and surgeries can all cause the body to need extra adrenal hormones, so patients often need to have extra doses of these medications in these situations. Patients must stay hydrated and consume extra sugar and salt to prevent dehydration and low blood sugar while on these medications.
