Adrenal Insufficiency
Adrenal insufficiency occurs when the adrenal glands, two small glands that sit above the kidneys, cannot produce enough cortisol. Aldosterone production may also be affected, particularly in primary adrenal insufficiency (Addison’s disease). Without these hormones the body cannot regulate blood pressure, blood sugar, or the response to physical stress.
Medicine used to treat Adrenal Insufficiency
Recognising the condition
Fatigue that does not improve with rest is often the first sign. Other common symptoms include low blood pressure (especially on standing), salt cravings, unintentional weight loss, nausea, and muscle weakness. Skin darkening around joints and scars is specific to primary adrenal insufficiency and reflects rising ACTH levels. Symptoms can be vague for months before a diagnosis is made.
An adrenal crisis, sudden severe vomiting, extreme weakness, or a sharp drop in blood pressure, is a medical emergency requiring immediate hospital care.
Replacing what the glands cannot make
Treatment centres on lifelong hormone therapy to replace the missing hormones. Cortisol is replaced daily with hydrocortisone (or an equivalent glucocorticoid). When aldosterone is also deficient, fludrocortisone is added to restore salt and fluid balance. Doses are typically adjusted upward during illness, surgery, or significant physical stress, a practice called sick-day dosing.