Adrenal insufficiency (patient information)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Jinhui Wu, MD

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How do I know if I have adrenal insufficiency and what are the symptoms of adrenal insufficiency?

The symptoms of adrenal insufficiency usually begin gradually. Usual symptoms include:

• Chronic, worsening fatigue
• Muscle weakness
• Loss of appetite
• Weight loss
• Nausea and vomiting
• Diarrhea
• Hypotension
• Hypoglycemia
• Headache

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

Who is at risk for adrenal insufficiency?

• Genetic defects of adrenal gland
• Underactive parathyroid glands
• Pernicious anemia
• Chronic fungal infections
• Chronic active hepatitis
• Diabetes
• Vitiligo
• Tuberculosis
• Amyloidosis
• AIDS
• Cancer
• Surgical removal of the pituitary gland or hypothalamus

How to know you have adrenal insufficiency?

• ACTH stimulation test: The ACTH stimulation test is the most common test for patients who are suspected of diagnosing adrenal insufficiency. During this test, before and after being injected ACTH, the patient is detected with the level of blood cortisol and urine cortisol. In normal person, after an ACTH injection, it may show a rise in blood and urine cortisol levels. Patients with causes of adrenal insufficiency have little or no increase in cortisol levels.
• CRH stimulation test: This test can differ the primary and secondary adrenal insufficiency. In this test, the patient is injected synthetic CRH and measured blood cortisol before and 30, 60, 90, and 120 minutes after the injection. The leval of blood cortisol in people with primary adrenal insufficiency such as Addison’s disease, demonatrates high levels of ACTH but no cortisol. For the patients with secondary adrenal insufficiency, they appear absent or delayed ACTH.
• Abdominal x-ray test: An x-ray image of abdomine allows the doctor to check the shape and size of the adrenal glands.
• Abdominal ultrasound: This is an painless test which uses sound waves to create a picture of the internal organs. It can help doctor reveal any signs in adrenal glands.
• Cranial CT and MRI: These imaging tests can confirm the size and shape of pituitary gland and hypothalamus and show the organs near them. It is useful for the diagnosis of secondary adrenal insufficiency. CT scan produce a series of x-ray pictures giving cross-sectional images. A magnetic resonance imaging (MRI) scan may show a three-dimensional image of this region.

When to seek urgent medical care?

The urgent, severe worsening symptoms adrenal insufficiency is called an addisonian crisis or acute adrenal insufficiency. It is fetal and needs urgent medical care. If you experience either of the following symptoms, seeking urgent medical care as soon as possible:

• Sudden, penetrating pain in the lower back, abdomen, or legs
• Severe vomiting and diarrhea
• Dehydration
• Hypotension
• Loss of consciousness

Diseases with similar symptoms

• Riehl's melanosis
• Hepatic cirrhosis
• Hemochromatosis
• Black acanthosis

Where to find medical care for adrenal insufficiency?

Directions to Hospitals Treating adrenal insufficiency

Copyleft Sources

http://jama.ama-assn.org/cgi/reprint/294/19/2528.pdf

http://www.endocrine.niddk.nih.gov/pubs/addison/addison.htm