From the Guidelines
Adrenal insufficiency is a condition where the adrenal glands do not produce enough hormones, such as cortisol and aldosterone, which are essential for maintaining energy, fighting infections, and handling stress.
Definition and Causes
Adrenal insufficiency can be primary or secondary, depending on the underlying cause. Primary adrenal insufficiency occurs when the adrenal glands are damaged, while secondary adrenal insufficiency occurs when the pituitary gland does not produce enough adrenocorticotropic hormone (ACTH) to stimulate the adrenal glands 1.
Symptoms and Diagnosis
The symptoms of adrenal insufficiency can vary, but common symptoms include fatigue, weight loss, low blood pressure, and decreased appetite. Diagnosis is typically made through a combination of physical examination, medical history, and laboratory tests, such as blood tests to measure cortisol and ACTH levels 1.
Treatment and Management
Treatment for adrenal insufficiency typically involves replacing the deficient hormones with medication, such as hydrocortisone and fludrocortisone. The goal of treatment is to restore normal hormone levels and alleviate symptoms. Patients with adrenal insufficiency also need to be educated on stress dosing, emergency injectables, and when to seek medical attention for impending adrenal crisis 1.
Key Considerations
- Early endocrinology consultation is crucial for patients with adrenal insufficiency, especially before surgery or high-stress treatments 1.
- Hydrocortisone is the preferred medication for replacing cortisol, as it allows for the recreation of the diurnal rhythm of cortisol 1.
- Patients need to be educated on stress dosing, emergency injectables, and when to seek medical attention for impending adrenal crisis 1.
- Dexamethasone is not adequate as glucocorticoid treatment in patients with primary adrenal insufficiency, as it has no mineralocorticoid activity 1.
From the FDA Drug Label
ACTIONS Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have salt-retaining properties, are used as replacement therapy in adrenocortical deficiency states.
Adrenal insufficiency is an adrenocortical deficiency state. It is a condition where the adrenal cortex does not produce adequate amounts of hormones, such as glucocorticoids. 2
From the Research
Definition and Causes of Adrenal Insufficiency
- Adrenal insufficiency is a rare disease characterized by the inadequate production of glucocorticoids and/or mineralocorticoids due to the failure of the adrenal cortex 3, 4, 5, 6, 7.
- It can result from the direct impairment of the adrenal glands (primary adrenal insufficiency) or from the diminished adrenocorticotropic hormone (ACTH) stimulation due to hypothalamic and/or pituitary damage (secondary adrenal insufficiency) 5, 6, 7.
- The most frequent cause of primary adrenal insufficiency in western countries is autoimmune adrenalitis, while secondary adrenal insufficiency is most often caused by pituitary tumors and their treatment 3.
Symptoms and Diagnosis
- Symptoms of adrenal insufficiency can be non-specific, including hypotension, weight loss, fatigue, and abdominal pain, making diagnosis challenging 4, 5, 6, 7.
- Diagnosis is based on clinical assessment and biochemical tests, including basal hormone level measurements and stimulation tests 5, 6.
- The diagnosis of adrenal insufficiency is made by demonstrating low basal and/or stimulated serum cortisol, followed by investigations to establish the underlying etiology 6.
Treatment and Management
- Chronic glucocorticoid replacement therapy is the main treatment for adrenal insufficiency, typically consisting of hydrocortisone 15-25 mg/day in divided doses 3, 4, 6.
- Patients with primary adrenal insufficiency also require mineralocorticoid replacement, usually with fludrocortisone 0.05-0.2 mg/day 3, 4, 6.
- Patient education is crucial in managing adrenal insufficiency, including the need for increased corticosteroid dose supplementation during stress periods and carrying a medical alert notification or steroid emergency card 4, 6, 7.