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This is general information developed by The Ottawa Hospital. It is not intended to replace the advice of a qualified health-care provider. Please consult your health-care provider who will be able to determine the appropriateness of the information for your specific situation.

What are adrenal glands?

The body normally has 2 adrenal glands, one above each kidney. These glands make several hormones. Cortisol is a hormone the adrenal gland makes that helps the body use sugar, fat and protein for energy. Cortisol also keeps your immune system in check and affects how bones are formed. The body also needs more cortisol to cope with stress and

illness. Aldosterone is another hormone made by adrenal glands that adjusts salt, potassium and water levels in the body. This helps regulate blood pressure. The body needs cortisol and aldosterone to function normally.

Adrenal Insufficiency

What is adrenal insufficiency?

Adrenal insufficiency happens when the body is not able to make enough cortisol. This can occur if the adrenal glands are damaged. Another type of adrenal insufficiency can occur if the pituitary gland in the brain is not able to make enough of a hormone called adrenocorticotropic hormone(ACTH). ACTH sends a message to the adrenal glands to make more cortisol. If the body is not making ACTH, then the adrenal glands will not make enough cortisol to keep the body working normally. When not treated with medication, adrenal insufficiency can cause severe illness and even death.

What is Addison’s disease?

This is the type of adrenal insufficiency that occurs when both adrenal glands are not able to make enough hormones. When a person has Addison’s disease, the body is not able to make enough cortisol or aldosterone. Addison’s disease is also called primary adrenal insufficiency.

What are the signs and symptoms of adrenal insufficiency?

  • Feeling tired or weak
  • Feeling lightheaded when standing up
  • Having low blood pressure
  • Nausea, vomiting, abdominal pain
  • Craving salt
  • Weight loss
  • Darkening of skin (like a tan without having had the time in the sun)

How is adrenal insufficiency treated?

People who have adrenal insufficiency must take medication to replace the cortisol that adrenal glands are unable to make. Taking this medication will help relieve the symptoms as well as regulate how the body uses sugar, fat and protein for energy. The medication will also help prevent low blood pressure. Doctors normally prescribe one of the following medications to treat cortisol deficiency:

  • Hydrocortisone (Cortef®)
  • Prednisone
  • Dexamethasone (Decadron®)

Usually people who have Addison’s disease must also take a medication to replace aldosterone. Fludrocortisone (Florinef®) is normally the medication used to treat aldosterone deficiency.

It is important that medications for adrenal insufficiency be taken every day at the same time. People who have adrenal insufficiency need to see a doctor regularly for blood pressure checks and blood tests to check if they are on the right doses of medications.

What are the side effects of the medications used to treat adrenal insufficiency?

At the correct doses, medications used to treat adrenal insufficiency do not cause serious side effects. If higher doses are used for a long time, high blood pressure, diabetes, weak muscles, thin skin, easy bruising and osteoporosis (weak bones) can occur.

How should adrenal insufficiency be treated during times of stress and illness?

The body needs more cortisol than usual at times of stress and illness. A person with adrenal insufficiency who is sick with an infection and fever (temperature higher than 38oC) should take double the usual dose of cortisol replacement

medication (hydrocortisone, prednisone or dexamethasone) for 1-3 days. If the illness lasts longer than 3 days, then treatment should be discussed with your doctor. If a person with adrenal insufficiency is not able to take medication by mouth because of nausea and vomiting, then the cortisol replacement medication must be given by injection. A person with adrenal insufficiency who is feeling weak and is not able to take medications should see a doctor right away. Your family doctor may be able to examine you and advise you. If you or your family doctor are unsure about how to adjust your cortisol replacement when you are sick, contact your endocrinologist.

Not being able to take treatment for adrenal insufficiency can lead to very serious illness. You should go to the nearest

emergency department if you:

  • Are sick and unable to take your medication
  • Are vomiting or have diarrhea
  • Have bad abdominal pain (belly ache)
  • Have muscle pain or cramps
  • Feel dizzy
  • Feel unusually weak and unwell

Are there other important precautions that a person with adrenal insufficiency should take?

People with adrenal insufficiency should wear a medical identification tag at all times stating they have this condition. Emergency health care providers must know when people have adrenal insufficiency so that they can make sure that the right treatment is given. You can buy an identification tag in a pharmacy, online or you can ask your healthcare professional if they can recommend where to buy one.

Additional information about adrenal insufficiency can be found at the following websites:

P1149 (06/2014)

Last updated on: November 1st, 2017