Can Mirena (levonorgestrel) IUD cause secondary adrenal insufficiency?

From the Guidelines

There is no established evidence that the Mirena IUD (levonorgestrel) causes secondary adrenal insufficiency. The Mirena IUD works primarily by releasing small amounts of levonorgestrel locally in the uterus, with minimal systemic absorption compared to oral hormonal contraceptives. Secondary adrenal insufficiency occurs when the pituitary gland fails to produce adequate ACTH hormone, which stimulates the adrenal glands to produce cortisol. The levonorgestrel in Mirena acts mainly on progesterone receptors in the uterine lining and does not directly interfere with the hypothalamic-pituitary-adrenal axis that regulates cortisol production.

While hormonal contraceptives can sometimes affect various body systems, the localized action and low systemic levels of hormone from the Mirena IUD make it unlikely to cause significant disruption to adrenal function. If a patient with a Mirena IUD experiences symptoms suggestive of adrenal insufficiency (such as fatigue, weakness, weight loss, or low blood pressure), they should seek medical evaluation, as these symptoms are more likely related to other causes. The management of adrenal insufficiency, as outlined in studies such as 1 and 1, involves corticosteroid replacement therapy and education on stress dosing, but this is not directly related to the use of the Mirena IUD.

Key points to consider include:

• The Mirena IUD has minimal systemic absorption of levonorgestrel compared to oral hormonal contraceptives.
• Secondary adrenal insufficiency is related to the pituitary gland's production of ACTH, which is not directly affected by the Mirena IUD.
• Patients with symptoms of adrenal insufficiency should seek medical evaluation to determine the underlying cause.
• The management of adrenal insufficiency, as discussed in 1 and 1, focuses on corticosteroid replacement and stress dosing, but this is not applicable to the Mirena IUD as a cause of secondary adrenal insufficiency.

From the Research

Secondary Adrenal Insufficiency and Mirena IUD

• There is no direct evidence in the provided studies that links Mirena (levonorgestrel) IUD to secondary adrenal insufficiency 2, 3, 4, 5, 6.
• Secondary adrenal insufficiency is typically caused by a lack of stimulation via pituitary adrenocorticotropic hormone or hypothalamic corticotropin-releasing hormone, often due to exogenous corticosteroid therapy, hypopituitarism, or central nervous system injury 3, 4.
• The provided studies discuss the diagnosis and management of adrenal insufficiency, including the use of corticosteroid replacement therapy and the importance of early detection and treatment to prevent adrenal crisis 3, 5, 6.
• None of the studies mention the use of Mirena IUD as a potential cause of secondary adrenal insufficiency, suggesting that there is no established link between the two 2, 3, 4, 5, 6.

Adrenal Insufficiency Causes and Diagnosis

• Secondary adrenal insufficiency can result from insufficient stimulation of the adrenal glands due to inadequate secretion or synthesis of adrenocorticotropic hormone (ACTH) 4.
• The diagnosis of secondary adrenal insufficiency can be confirmed using the cosyntropin (Synacthen®) stimulation test or the insulin tolerance test, which is the gold standard for secondary adrenal insufficiency 3.
• The underlying cause of adrenal insufficiency can often be identified via a strategic approach to investigation, including clinical suspicion and laboratory testing 3, 5.

Treatment and Management

• The treatment of secondary adrenal insufficiency typically involves corticosteroid replacement therapy, with the goal of replacing the deficient hormones and preventing adrenal crisis 5, 6.
• The use of modified-release hydrocortisone formulations may be beneficial in the treatment of secondary adrenal insufficiency, particularly in cases of ACTH deficiency 6.