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Adrenal Insufficiency - What Causes It?

Written and reviewed by
MBBS, FCPS - Medicine, DNB - General Medicine (I)
Diabetologist, Pune  •  24 years experience
Adrenal Insufficiency - What Causes It?

Adrenal insufficiency is a condition in which the adrenal glands of the patient do not produce sufficient amount of steroid hormones. It mostly affects the production of cortisol but in some cases, the production of aldosterone may also be reduced. At times, dysfunction of the hypothalamus or the pituitary gland can also cause adrenal insufficiency because the hormones produced by these two glands help in regulating the functions performed by hormones secreted by the adrenal gland. These steroid hormones play an important role in bodily functions such as metabolism, immunity development, salt/water balance, sexual development and others. So, when these hormones are not produced in adequate amount, the individual experiences specific problems and thus, treatment for adrenal insufficiency becomes necessary.

Causes: Adrenal insufficiency can be caused by many reasons. Sudden withdrawal of long-term corticosteroid therapy, adrenoleukodystrophy, stress in people who already suffer from chronic adrenal insufficiency, craniopharyngioma, and Waterhouse-Friderichsen syndrome are responsible for adrenal insufficiency. In some cases, Addison's disease and congenital adrenal hyperplasia also surface in the form of adrenal insufficiency.

Adrenal insufficiency can be categorized into three sections based on the ways through which they affect the adrenal gland and cause the low production of cortisol and other steroid hormones.

  1. The first is adrenal dysgenesis in which the gland has not formed properly in the patient.
  2. The second is impaired steroidogenesis in which the gland is not able to produce cortisol due to biochemical inefficiency
  3. The third is adrenal destruction in which the gland gets damaged because of some disease.

Symptoms:

The symptoms of adrenal insufficiency manifest in the form of dehydration, weight loss, weakness, low blood pressure, muscle pain, hypoglycemia (low blood sugar) vomiting, diarrhea, craving for salt or salty food, change in mood, kidney failure, and shock. These symptoms are a result of hormonal deficiency caused by adrenal insufficiency and if not taken seriously, they can affect the patient seriously.

Diagnosis and Treatment: Adrenal insufficiency can be diagnosed with the help of adrenocorticotropic hormone (ACTH) stimulation test, which examines the functioning of the adrenal gland. A CT scan of the adrenal gland can also detect structural abnormalities in it. An MRI scan of the pituitary gland is also recommended in some cases as this gland also plays a secondary role in adrenal insufficiency. Adrenal insufficiency can be treated by giving the patient hormonal therapy. The hormones are given in the form of medications. Since cortisol inadequacy is the primary effect of adrenal insufficiency, it is supplemented with the help of medicines such as hydrocortisone (Cortef), prednisone (Deltasone), prednisolone (Delta-Cortef), methylprednisolone (Medrol) and dexamethasone (Decadron).

In cases of severe adrenal insufficiency, the patient is given intravenous fluids and intravenous steroids, which can give relief from the discomforting symptoms. Where the patient is found to be suffering from mineralocorticoid deficiency (low aldosterone), fludrocortisone acetate is given to balance the sodium and potassium imbalance. It should be remembered that the adrenal gland performs vital functions in the body and if it is deficient, then the body is bound to suffer. So, the patient should go for immediate diagnosis and follow the treatment therapy prescribed by the doctor. In case you have a concern or query you can always consult an expert & get answers to your questions!

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