Adrenal Insufficiency

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Learn all about adrenal insufficiency – its causes, symptoms, and effective management strategies. Whether you're newly diagnosed or seeking to enhance your understanding, our goal is to equip you with the knowledge you need to thrive.

Central adrenal insufficiency, also known as secondary adrenal insufficiency, is a medical condition characterized by inadequate production of cortisol and sometimes other adrenal hormones due to dysfunction in the pituitary gland or hypothalamus. These vital glands are responsible for regulating the body’s stress response and maintaining hormonal balance.

Causes and Mechanisms

Central adrenal insufficiency can be caused by various factors, including:

  1. Pituitary Dysfunction: The pituitary gland, often referred to as the “master gland,” produces adrenocorticotropic hormone (ACTH) that stimulates the adrenal glands to release cortisol. If the pituitary gland malfunctions due to tumors, inflammation, or surgery, it can lead to reduced ACTH production and subsequently lower cortisol levels.
  2. Hypothalamic Dysfunction: The hypothalamus produces corticotropin-releasing hormone (CRH), which stimulates the pituitary gland to release ACTH. Dysfunction in the hypothalamus can disrupt this process and lead to central adrenal insufficiency.


Common symptoms of central adrenal insufficiency may include:

  • Fatigue and weakness
  • Weight loss and decreased appetite
  • Low blood pressure
  • Dizziness upon standing (orthostatic hypotension)
  • Nausea and vomiting
  • Abdominal pain
  • Skin changes (hyperpigmentation)
  • Hypoglycemia (low blood sugar)
  • Emotional disturbances

Diagnosis and Treatment

Diagnosis typically involves blood tests to measure cortisol and ACTH levels, as well as dynamic tests to assess the adrenal gland’s response to stimulation. Treatment revolves around replacing the deficient cortisol with hormone replacement therapy, usually in the form of oral hydrocortisone tablets. Close medical supervision is crucial to finding the appropriate dosage and adjusting it based on individual needs.

Managing Central Adrenal Insufficiency

Patients with central adrenal insufficiency should:

  • Medication Adherence: Follow their prescribed medication regimen diligently and never skip doses.
  • Stress Management: Learn stress-reduction techniques and be cautious during illness or injury, as these situations may require increased cortisol doses.
  • Medical ID: Wear a medical alert bracelet or carry an identification card to inform healthcare providers of their condition.
  • Regular Follow-ups: Schedule regular check-ups to monitor hormone levels and adjust medication as necessary.
  • Education: Educate themselves and their loved ones about the condition, its symptoms, and the importance of proper management.


Central adrenal insufficiency requires careful management and ongoing communication with healthcare providers. By adhering to treatment plans and adopting a proactive approach to health, individuals with this condition can lead fulfilling lives while effectively managing their hormonal balance.

For personalized advice and information, consult a medical professional specializing in endocrinology or hormonal disorders.

Other Resources:
Adrenal Insufficiency United
National Organization for Rare Disorders (NORD)

Learn More about Adrenal Insufficiency

Adrenal Insufficiency and Cortisol Replacement

There are many questions around replacing cortisol for hypothalamic-pituitary brain tumor patients that have developed adrenal insufficiency. From dosages and timing of dosing, when to stress dose and the effects of long-term steroid use to weight gain and increased hunger, this video explores these topics.

How to administer Solu-Cortef emergency injection (hydrocortisone injection)

Emergency stress dosing can be scary. Here is a video to help you step by step with the injection process.

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