Adrenal Insufficiency
Adrenal insufficiency is inadequate production of cortisol, with aldosterone also affected in primary disease, leaving the body unable to respond normally to physical stress.
Key points
- Fatigue, weight loss, nausea, dizziness and low blood pressure can develop gradually and overlap with many other conditions.
- Daily hormone replacement must be adjusted during illness or surgery according to an agreed sick-day plan.
- Abrupt vomiting, profound weakness, confusion or collapse may indicate adrenal crisis and requires emergency treatment.
The listings below require a confirmed diagnosis and an individual replacement and emergency plan.
Confirming the cause
Morning cortisol and an ACTH stimulation test may be used, with ACTH, electrolytes and imaging helping distinguish primary adrenal disease from pituitary or medicine-related causes. Long-term corticosteroid use can suppress normal cortisol production and should not be stopped suddenly.
Living safely with replacement
Glucocorticoid replacement is timed to approximate normal cortisol patterns; mineralocorticoid may also be needed in primary disease. Patients need written sick-day instructions, emergency identification and access to injectable steroid when advised. Persistent over-replacement also causes harm and should be reviewed.
When to seek urgent care
Use the emergency plan and seek urgent help for repeated vomiting, severe diarrhoea, confusion, collapse, very low blood pressure, extreme weakness or inability to keep steroid medicine down.