Adrenal Insufficiency: 9 Things Doctors Want You to Know

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    Working With Your Doctor to Treat Adrenal Insufficiency
    Adrenal insufficiency, or AI, means your adrenal glands, which are above your kidneys, are not producing enough of the hormones that regulate essential body functions. An endocrinologist who specializes in hormone-related diseases can diagnose and treat you. The key to managing your AI is understanding how to adjust the medication that replaces the missing hormones, because the amount you need can go up and down. Here’s what some top endocrinologists say about adrenal insufficiency.
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    1. “Adrenal insufficiency symptoms look like many other illnesses.”
    “Symptoms of adrenal insufficiency include profound fatigue, weight loss, loss of appetite, abdominal pain, nausea, vomiting, and light-headedness,” says Elizabeth McAninch, MD, an endocrinologist at Rush University Medical Center in Chicago. There can be many causes for these symptoms and AI can be tricky to diagnose. “We have to be hormone detectives,” says Margaret Weirman, MD, endocrinologist with UC Health in Aurora, Colorado. “When a person comes to me with non-specific symptoms, I do a fatigue panel,” to assess if they may have AI, says Irina Bancos, MD, endocrinologist at the Mayo Clinic in Rochester, Minnesota. A fatigue panel is a blood test that checks, among other things, adrenal hormone levels.
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    2. “If you have AI, you should understand what steroid hormones do.”
    “The adrenal glands make hormones that are necessary to live. Steroids are hormones made from cholesterol, one of which is cortisol. Cortisol is responsible for maintaining your blood pressure and your blood sugar. It affects nearly every tissue in the body—your liver, your fat, your muscles, kidneys, bone, heart, immune system – so it’s just very important to have adequate hormone levels,” says Dr McAninch. “If a person thinks they may have adrenal insufficiency, they should ask their physician if it’s a possibility,” says Dr. Bancos. A primary physician can refer you to an endocrinologist if needed.
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    3. “The more common kind of AI is called secondary adrenal insufficiency.”
    “In secondary adrenal insufficiency, the adrenal glands are not receiving signals from the pituitary gland [near the base of the brain] to secrete enough hormones,” says Dr. McAninch. “The most common cause is when a patient has been taking some sort of synthetic cortisol like prednisone—something that their doctor has given them that puts their pituitary to sleep. That would be inhaled steroids, oral steroids, injectable steroids,” says Dr. Weirman. Without those signals, the body stops making its own cortisol. Do not stop taking steroid drugs without consulting your doctor, even if you think you may have AI.
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    4. “The other form of AI is rare and affects more than your cortisol levels.”
    Primary AI, or Addison’s disease, is usually caused by an autoimmune disorder. If you have Addison’s, your adrenal glands are damaged and do not function. “Primary adrenal insufficiency is when the adrenal glands are unable to make hormones,” says Dr. McAninch. “The [symptoms] are more severe. In addition to not making cortisol, they are not making the hormone aldosterone, so there are problems with salt and water balance in the body,” says Dr. Weirman. Areas of your skin may darken when you have Addison’s disease, which can help lead to a diagnosis.
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    5. “We can replace the missing hormones – but the dosage is a moving target.”
    Your endocrinologist can prescribe steroids to replace what your body isn’t making, but the dose varies. “You might have a patient that is 20 years old and weighs 100 pounds or you might have a patient that’s 20 years old and weighs 400 lbs. Those steroid requirements might not be the same,” says Dr. McAninch. “It’s a fine balance to get the right dose between undertreated and overtreated. In illness or stress, you might need more. If you’re running a marathon one day you might need more, but if you’re not running a marathon the next day, you might need less,” she adds.
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    6. “Know when you should increase or change how you take your AI medication.”
    Your doctor can teach you when to change your medication to keep your hormones balanced and your body functioning well. It’s often needed during physical (not emotional) stress. “If you have fever or chills, you might double your dose. If you feel nauseated, have diarrhea and are not sure you are absorbing your pills, it’s a good situation to inject your steroids. Or inject when you’re not allowed to take anything by mouth, like before a colonoscopy or tooth extraction,” says Dr. Bancos. Over time, you’ll become familiar with adjusting your dosage, but if you ever have questions, call your endocrinologist.
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    7. “You need to be prepared for adrenal emergencies.”
    “Adrenal crisis is a life-threatening medical emergency, where a patient has critically low cortisol levels that don’t meet their body’s demands,” says Dr. McAninch. “Patients can develop low blood pressure, lightheadedness, loss of consciousness, nausea, vomiting, confusion, headaches, or muscle aches. It requires emergency medical care. The ER or hospital will treat you with IV steroids and IV fluids.” “Always wear a medical alert bracelet indicating you have adrenal insufficiency. You should also have an emergency steroid injection kit in case of an adrenal crisis. This involves you or a loved one administering an injection of steroids,” adds Dr. Weirman.
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    8. “Be aware that steroid drugs can cause secondary adrenal insufficiency."
    “Steroid drugs are prescribed for a multitude of issues. People use steroid skin creams, eye drops, nasal sprays, inhalers, injections for the joints, pills for asthma and sinus infections, pain, lupus, and inflammation. Exposure to these steroids over time can cause adrenal insufficiency, because it suppresses your ability to make your own hormones. I’m not saying not to take them, but confirm with your doctor if it’s needed and why it’s needed,” says Dr. McAninch. Even over-the-counter steroids can suppress hormone production, though a person would have to use a considerable amount for it to become a health problem.
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    9. “With proper medication, you can lead an active, normal life with AI.”
    “Ninety-five percent of my patients do really well. AI can be managed beautifully,” says Dr. Bancos. “Once they’ve been diagnosed. they should be asking about treatment. Am I on the correct dose? How are you going to monitor my dose, because I don’t want to be undertreated or overtreated. How am I going to take care of myself in the event of illness or stress? And what am I going to do in case of emergency? The key to a good treatment plan is communication between the doctor and patient or their family,” says Dr. McAninch.
Adrenal Insufficiency: 9 Things Doctors Want You to Know
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About The Author

Nancy LeBrun is an Emmy- and Peabody award-winning writer and producer who has been writing about health and wellness for more than five years. She is a member of the Association of Health Care Journalists and the American Society of Journalists and Authors.
  1. Adrenal Insufficiency & Addison’s Disease. National Institute of Diabetes Digestive and Kidney Disease. https://www.niddk.nih.gov/health-information/endocrine-diseases/adrenal-insufficiency-addisons-disease
  2. Adrenal Insufficiency. Hormone Health Network. https://www.hormone.org/diseases-and-conditions/adrenal-insufficiency
  3. Secondary Adrenal Insufficiency. National Adrenal Diseases Foundation. https://www.nadf.us/adrenal-diseases/secondary-adrenal-insufficiency/
  4. Steroids and Adrenal Suppression. Adrenal Insufficiency United.http://aiunited.org/wp-content/uploads/STEROIDS-ASTHMA.pdf
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Apr 10
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