Secondary Adrenal Insufficiency

What is secondary adrenal insufficiency?

• Secondary adrenal insufficiency (SAI) is a condition where your body does not make enough hormones (body chemicals). The middle part of your brain holds the pea-sized pituitary gland which makes adrenocorticotropin hormone, or ACTH. ACTH sends signals to your adrenal glands to make another hormone called cortisol. This hormone helps control how your body uses sugar, fats, and proteins. It helps your body cope with stress and fight certain infections. The hormone keeps the fluid and salt balance in your body and your blood pressure normal.
  
  
• SAI happens when your pituitary gland does not make enough ACTH. Without ACTH, your cortisol levels will also decrease. When the amounts of these hormones become too low, it may lead to an adrenal crisis. An adrenal crisis is a life-threatening condition that worsens your symptoms and may cause death. Treating your SAI will help decrease and relieve your symptoms, and prevent an adrenal crisis.

What causes secondary adrenal insufficiency?

Any procedure, condition, or disease that involves your brain, and pituitary gland may cause SAI. SAI may be caused by any of the following:

• Childbirth problems: Females that lose large amounts of blood during or after childbirth may be at risk of having SAI. This happens when blood flow and oxygen levels to your pituitary gland decrease, and cells die.
  
  
• Medical conditions: Certain diseases such as sarcoidosis and infections such as HIV and blood infections may cause SAI. Ask your caregiver for information about these conditions.
  
  
• Medicines: Long term treatment with steroid medicines commonly causes SAI. Your risk of having the condition increases if you suddenly stop taking your steroid medicines. Certain pain and antidepressant medicines may also increase your risk of having SAI. Ask your caregiver for more information about these medicines.
  
  
• Radiation therapy: Having previous radiation treatment on your head may cause damage to your brain and pituitary gland
  
  
• Surgery: Any procedure or surgery involving your brain and pituitary gland may cause a decrease in your hormone levels. This may include surgery to remove tumors.
  
  
• Trauma: Direct trauma or injury to your head may cause bleeding and damage to your brain and pituitary gland. Having blood clots in your brain may put pressure on your pituitary gland and damage it. Your pituitary gland may stop working correctly for a short time or for the rest of your life.
  
  
• Tumors: Certain brain and pituitary gland tumors may decrease your hormone levels. Tumors from other body organs that spread to the brain may also decrease your hormones and cause SAI.

What are the signs and symptoms of secondary adrenal insufficiency?

Signs and symptoms may show up slowly over months or years. You may have any of the following:

• General:
  
  
  • Decreased appetite and weight loss.
    
    
  • Dizziness when standing up from a sitting or lying position.
    
    
  • Increased sweating and shaking.
    
    
  • Joint pain.
    
    
  • Nausea (upset stomach), vomiting (throwing up), and abdominal (stomach) cramps.
    
    
  • Pale (decreased color) skin.
    
    
  • Weakness and tiredness.
  
  
• Other signs and symptoms:
  
  
  • Decreased desire for sex.
    
    
  • Decreased or total loss of body hair, mostly on your underarms and pubic area.
    
    
  • Depression (deep sadness).
    
    
  • Impotence (difficulty getting or keeping an erection for men).

How is secondary adrenal insufficiency diagnosed?

Your caregiver will ask you about your health and medical history. This may include information about what signs and symptoms you have, and when they started. You may need any of the following:

• Blood tests: You may need blood taken for tests. These tests tell your caregiver how high or low hormone levels are in your blood. Other blood tests may be done to give your caregivers more information about your health. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. You may need to have blood drawn more than once.
  
  
• Chemical stimulation tests: Your blood will be tested first and then you will be given a shot of special chemicals. The chemicals will cause your pituitary and adrenal glands to make hormones. After several minutes, your hormone levels in your blood are tested again. Ask your caregiver for information about this test.
  
  
• Urine test: This may include measuring the amount of hormones in your urine.

How is secondary adrenal insufficiency treated?

You may be given any of the following:

• Medicine:
  
  
  • Steroid medicine: This medicine is given because your body is not making enough hormones. This medicine may help you feel better, but may also have unwanted effects. You may need to take this medicine for the rest of your life. You may need to change how much medicine you take when you are ill or have increased stress. Do not stop taking this medicine without talking to your caregiver. Stopping on your own may cause a very bad response. Talk to your caregiver about this medicine and why you need it.
    
    
  • Hormone replacement therapy: This treatment will replace the hormones needed by your body. You may be given this treatment for a long period of time. You may need to take this medicine for the rest of your life. Ask your caregiver for more information about hormone replacement therapy.
  
  
• Other treatments:
  
  
  • Intravenous therapy: This is a special liquid given to replace the fluid that your body has lost. It will help keep the fluid and salt balance in your body normal. An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
    
    

When should I call my caregiver?

Call your caregiver if:

• You have a fever.
  
  
• You have diarrhea (loose watery bowel movements).
  
  
• You have nausea, vomiting, or abdominal pain.
  
  
• You sweat or pass more urine than usual.
  
  
• You have questions or concerns about your condition, treatment, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You always feel dizzy when you stand up from a sitting or lying position.
  
  
• You have high blood sugar levels or high blood pressure.
  
  
• You have very bad pain in your stomach, waist, or back.
  
  
• You have very dry skin, dry mouth and tongue, or feel very thirsty.
  
  
• Your symptoms become worse, even after taking medicines.

Where can I get more information?

Having SAI may be life changing for you and your family. You may feel angry, sad, or frightened. These feelings are normal. Talk to your caregiver's, family, or friends about your feelings. Contact the following:

• National Adrenal Diseases Foundation
  505 Northern Boulevard
  Great Neck , NY 11021
  Phone: 1- 516 - 487-4992
  Web Address: http://www.medhelp.org/nadf
  

• Endocrine and Metabolic Diseases Information Service
  National Institutes of Health
  6 Information Way
  Bethesda , MD 20892-3569
  Phone: 1- 888 - 828-0904
  Web Address: http://www.endocrine.niddk.nih.gov
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.