From the Guidelines
Secondary adrenal insufficiency symptoms include fatigue, weakness, weight loss, decreased appetite, nausea, vomiting, abdominal pain, low blood pressure, dizziness, and salt cravings, which occur due to the pituitary gland's failure to produce adequate adrenocorticotropic hormone (ACTH) to stimulate cortisol production in the adrenal glands. These symptoms are a result of the inadequate production of cortisol, a crucial hormone for the body's response to stress, regulating blood sugar, and maintaining blood pressure. The most recent and highest quality study, 1, highlights the importance of recognizing these symptoms, especially in patients with a history of adrenal crisis, as they can be precipitated by various triggers such as gastroenteritis, fever, surgical episodes, pregnancy, emotional distress, and other wide-ranging triggers. Key symptoms to look out for include:
- Fatigue and weakness
- Weight loss and decreased appetite
- Nausea, vomiting, and abdominal pain
- Low blood pressure and dizziness
- Salt cravings It is essential to address the underlying cause of secondary adrenal insufficiency, such as pituitary tumors or autoimmune disorders, for comprehensive management. Treatment typically involves hormone replacement therapy with glucocorticoids like hydrocortisone or prednisone, and some patients may also need mineralocorticoid replacement with fludrocortisone. Regular monitoring of hormone levels and electrolytes is crucial to adjust medication dosages, and patients should carry an emergency injection kit with hydrocortisone and wear a medical alert bracelet. During times of illness or stress, glucocorticoid doses should be doubled or tripled, as recommended by 1 and 1. It is vital to note that patients with comorbidities, such as asthma and diabetes, are more vulnerable to adrenal crisis, and those with mineralocorticoid or vasopressin dependency are less stable than secondary adrenal patients with intact mineralocorticoid function, as reported in 1. Overall, recognizing the symptoms of secondary adrenal insufficiency and providing appropriate treatment and management is crucial to preventing adrenal crisis and improving patient outcomes, as emphasized in 1.
From the FDA Drug Label
Since mineralocorticoid secretion may be impaired, salt and/or a mineralocorticoid should be administered concurrently. Drug-induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage. This type of relative insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, hormone therapy should be reinstituted Secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress, as in trauma, surgery or illness
The symptoms of secondary adrenal insufficiency are not explicitly stated in the drug labels. However, based on the information provided, it can be inferred that secondary adrenal insufficiency may manifest as an inability to respond to stress, which can occur after discontinuation of corticosteroid therapy or during times of trauma, surgery, or illness 2, 2.
- Key points:
- Relative insufficiency may persist for months after discontinuation of therapy
- Hormone therapy should be reinstituted in situations of stress
- Secondary adrenocortical and pituitary unresponsiveness can occur, particularly in times of stress.
From the Research
Symptoms of Secondary Adrenal Insufficiency
The symptoms of secondary adrenal insufficiency are not explicitly stated in the provided studies. However, the studies discuss the causes, treatment, and management of adrenal insufficiency in general.
Causes and Treatment
- Secondary adrenal insufficiency is most often caused by pituitary tumours and their treatment (e.g., surgery) 3.
- The standard treatment regimen involves twice- or thrice-daily dosing with a glucocorticoid, most commonly oral hydrocortisone 4, 5.
- Mineralocorticoid and salt replacement therapy is also necessary in primary adrenal insufficiency with aldosterone deficiency 6.
Management and Monitoring
- Patients with adrenal insufficiency are at risk of adrenal crisis, usually precipitated by major stress, such as severe infection or surgery 3, 7.
- Early dose adjustments are required to cover the increased glucocorticoid demand in stress 3.
- Patients should be monitored regularly, with clinical evaluation including weight gain, growth rate, blood pressure, and general well-being of the patient 6.
- Education on recognition of conditions leading to adrenal crisis, signs of adrenal crisis, and how to respond to an impending adrenal crisis is crucial 6.