What is secondary adrenal insufficiency?

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.

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.

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.

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.

• Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• Wear medical alert jewelry. This lets others know that you have adrenal insufficiency.
• Have a shot of emergency medicine with you at all times. Know when and how to give yourself the shot. Have instructions written out. Teach someone else how to give you the shot in case you can't give it to yourself.
• Keep track of your blood pressure. Let your doctor know if it's high or too low. Also let your doctor know if you have swelling or you feel lightheaded. You may need to adjust your dose of medicine.
• Work with your doctor to create a plan for what to do when you're sick or when your body is under stress. You may need to change your dose of medicine during this time.
• Weigh yourself regularly, especially if you haven't felt like eating or you have been vomiting. Weigh yourself at the same time each day and wear the same clothes each time you weigh yourself. Let your doctor know if you're losing weight or vomiting often.