Adrenal Insufficiency: Causes, Symptoms, Diagnosis, Treatment and Prognosis

The adrenal glands are small but very powerful glands that sit on top of each of the kidneys located in the middle of the back.

Adrenal insufficiency, or Addison’s disease, is a condition in which the adrenal glands do not produce adequate amounts of steroid hormones, mainly cortisol.

But it can also include impaired production of aldosterone (a mineral corticosteroid), which regulates sodium conservation, potassium secretion, and water retention .

They are actually two separate organs whose outer portion is called the adrenal cortex and the inner portion called the adrenal medulla.

The cortex has primarily a hormonal function.

Among the main functions of the adrenal cortex are the regulation of mineral metabolism (sodium, potassium, chloride), water balance, metabolism (use and distribution of carbohydrates, proteins and fats).

Allergies and immune reactions, production of male and female hormones (progesterone, testosterone, estrogens, dehydroepiandrosterone, among others).

Primary adrenal insufficiency is due to an alteration of the adrenal glands where the cortex of the gland is damaged and does not produce hormones in adequate amounts.

Causes of adrenal insufficiency

The failure of the adrenal glands to produce adrenocortical hormones is the result of the body attacking itself (autoimmune disease).

For unknown reasons, your immune system sees the adrenal cortex as something strange, something to attack and destroy.

Other causes of adrenal insufficiency are:

  • Diseases such as tuberculosis, bleeding, cancer, or the presence of adrenal gland infections.
  • Lack of adrenocorticotropic hormone, which causes a drop in cortisol production in the adrenal glands.
  • Surgical removal of benign or non-cancerous tumors of the pituitary gland (Cushing’s disease) that produce adrenocorticotropic hormone.
  • The abrupt discontinuation of corticosteroids used to treat conditions such as asthma or arthritis.


Symptoms usually come on slowly, and can include:

  • Fatigue and muscle weakness.
  • Decreased appetite and consequently a loss of weight.
  • Hyperpigmentation of the skin. The characteristic sites of tanning are the folds of the skin, the hands and the inside of the cheek or oral mucosa.
  • Low blood pressure, which decreases more when standing ( orthostatic hypotension ), even fainting occurs.
  • Salt craving.
  • Low blood sugar ( hypoglycemia ).
  • Nausea, diarrhea, or vomiting.
  • Dehydration
  • Disorientation.
  • Muscle or joint pain
  • Irritability.
  • Depression .
  • Body hair loss or sexual dysfunction in women.
  • Penetrating pain in the lower back, abdomen, or legs.
  • Loss of consciousness.

Diagnosis of adrenal insufficiency

If left untreated, adrenal insufficiency can lead to adrenal shock or crisis.

To make the diagnosis, the doctor may request tests such as:

Adrenocorticotropic hormone stimulation

The best diagnostic tool to confirm adrenal insufficiency is the adrenocorticotropic hormone stimulation test.

This test measures the level of cortisol in the blood before and after giving a patient an injection of synthetic adrenocorticotropic hormone.

The adrenocorticotropic hormone signals your adrenal glands to make cortisol.

If the production of cortisol after the application of the hormone is limited or non-existent, the adrenal glands are damaged.

Blood tests

Blood tests can measure blood levels of sodium, potassium, cortisol, thyroid hormone levels, adrenocorticotropic hormone, and antibodies associated with autoimmune Addison’s disease.

Insulin-induced hypoglycemia

This test checks blood sugar and cortisol levels at various intervals after giving an insulin injection.

Treatment of adrenal insufficiency

Treatment of adrenal insufficiency involves replacing or replacing hormones that the adrenal glands do not produce.

In the case of cortisol, it is administered orally with hydrocortisone, which is a synthetic glucocorticoid.

When aldosterone is deficient, a mineral corticosteroid called fludrocortisone acetate is given orally.

Phosphoric acid will be suitable for a patient with extreme physical exhaustion, inertia, apathy, and sexual weakness.

These people often complain of hair loss and even changes in visual acuity.

All its pathology arises from the hypo-function of the endocrine system, particularly of the adrenal glands.


Adrenal crisis can be fatal and requires immediate attention.

It is a life-threatening situation that results in low blood pressure, low blood sugar, and high blood potassium levels.