What is secondary adrenal insufficiency?

Your adrenal glands sit on top of your kidneys. They make hormones that affect almost every organ in your body.

Secondary adrenal insufficiency means that your adrenal glands don't make enough of a hormone called cortisol. Cortisol helps maintain blood pressure. It helps break down sugar and fat for energy. It also helps manage stress.

The problem starts with the pituitary gland. It's located at the base of your brain. Normally it sends a signal to the adrenal glands to make more cortisol. The signal is a hormone that the pituitary gland makes, called ACTH. When the pituitary gland doesn't make enough ACTH, the adrenal glands won't make enough cortisol.

This can happen if the pituitary gland is damaged by things like a tumor or surgery.

Treatment involves replacing the hormones that your body needs. You might get some of these hormones in the hospital. Some people will take hormones at home for the rest of their lives. Hormones may be pills or injections (shots).

If possible, your doctor will treat the condition that damaged the pituitary gland.

Some people may need urgent care because they have what is called an adrenal crisis. It can be caused by severe infection or stress. Symptoms may include:

• Severe vomiting and diarrhea.
• Extreme weakness.
• A high fever.

With secondary adrenocortical insufficiency, only cortisol is low. The adrenal glands can usually still make normal amounts of the hormone aldosterone. Symptoms include:

• Fatigue and muscle weakness. These may get worse over time.
• Weight loss. Profound weight loss is a prominent symptom.
• Loss of appetite.
• Headaches.

If possible, your doctor will treat the condition that is causing secondary adrenocortical insufficiency. Treatment will also include medicines like corticosteroids (hydrocortisone). You and your doctor will work together to find the dose that works best for you. It is also important to ask your doctor what to do when your body is under stress.

Diagnosis starts with a medical history and physical exam. If your doctor suspects adrenal insufficiency, the doctor will check your blood cortisol and ACTH levels. You may have imaging tests of the adrenal glands, the pituitary gland, or the hypothalamus.

CT scan or MRI can be used to see if there are signs of damage to the brain or pituitary gland (such as a tumor) that is causing adrenal failure.

Follow your treatment plan, including taking your medicines as prescribed. Carry a shot of emergency medicine at all times. Wear a medical ID tag. Weigh yourself regularly, and track your blood pressure. See your doctor if you're losing weight or if your blood pressure gets too high or too low.

Secondary adrenocortical insufficiency is a condition in which a lack of adrenocorticotropic hormone (ACTH) prevents the body from producing enough cortisol.

Production of cortisol is controlled by the action of ACTH. ACTH is produced by the pituitary gland. This gland is controlled by the hypothalamus in the brain. If either the hypothalamus or pituitary gland is damaged, less ACTH is produced. This can lead to problems with the adrenal glands and reduced cortisol production.

Secondary adrenocortical insufficiency may be caused by:

• A tumor of the pituitary gland or hypothalamus.
• Past radiation of the hypothalamus or pituitary gland.
• Past surgery to the pituitary gland.
• Rare conditions such as hemochromatosis, sarcoidosis, or Sheehan's syndrome (hypopituitarism). Sheehan's syndrome is sometimes caused by severe blood loss after giving birth.