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Secondary Adrenal Insufficiency


What is secondary adrenal insufficiency?

Secondary adrenal insufficiency (SAI) is a condition that develops when your adrenal glands do not make enough adrenal hormones. The adrenal glands are controlled by the pituitary gland in the brain. SAI develops when the pituitary gland does not make enough of a chemical called ACTH to control adrenal hormone production. Adrenal hormones such as cortisol help your body handle stress, keep blood pressure normal, and balance salt and fluids. They also control how your body uses sugars, fats, and proteins. An adrenal crisis may happen if your adrenal hormone level becomes too low. This condition is life-threatening and needs immediate treatment.

What causes secondary adrenal insufficiency?

Any procedure, condition, or disease that involves your pituitary gland may cause SAI.

  • Childbirth problems: Women who lose large amounts of blood during or after childbirth can develop SAI because of damage to the pituitary gland.
  • Medical conditions: Certain diseases and infections may cause SAI. Ask your healthcare provider for information about these conditions.
  • Medicines: Long-term treatment with steroid medicines for other conditions commonly causes SAI. This may be temporary or permanent. Your risk of SAI also increases if you suddenly stop taking your steroid medicines. Other medicines may also increase your risk of SAI. Ask your healthcare provider if any of the medicines you take increase your risk of SAI.
  • Radiation therapy: Radiation treatment on your head may cause damage to your brain and pituitary gland.
  • Trauma: Surgery, direct trauma, or injury to your head may cause bleeding and damage to your pituitary gland. 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 cause SAI. Tumors from other organs that spread to the brain may also cause SAI.

What are the signs and symptoms of secondary adrenal insufficiency?

Signs and symptoms may develop slowly over months or years:

  • Dizziness, weakness, and tiredness
  • Nausea, vomiting, decreased appetite, and weight loss
  • Depression or trouble thinking clearly
  • Muscle, joint, and back pain
  • Loss of hair or white patches of skin
  • Darkening of certain skin areas such as sun-exposed areas, nipples, genital area, and the inside of your mouth
  • Desire for certain foods, such as licorice and salty foods

How is secondary adrenal insufficiency diagnosed?

Your healthcare provider will ask about your symptoms and when they started. He may ask about your medical history. You may also need any of the following:

  • Blood tests: Your blood is tested to measure hormone levels and to check for health problems your SAI may be causing.
  • Urine test: Your urine is tested for the amount of adrenal hormones it contains.
  • Chemical stimulation tests: Your blood is tested twice in this test. The first time it is tested to measure the hormone levels. Then you are given a shot of chemicals to cause your pituitary and adrenal glands to make hormones. Your blood is tested a second time to see if the hormone levels increased.

How is secondary adrenal insufficiency treated?

Steroid medicine is given to balance the level of steroid hormones your adrenals naturally make. You may need to take this medicine for the rest of your life. You may need to change the amount you take when you are ill or have increased stress. Your healthcare provider will order medicine that can be given as a shot if you have an adrenal crisis. Ask your healthcare provider to show you and a friend or family member how to do this. Do not stop taking this medicine before you talk to your healthcare provider. You can trigger an adrenal crisis if you stop taking steroids suddenly.

What are the risks of secondary adrenal insufficiency?

  • You may have an allergic reaction to the medicines used to treat your SAI. The medicines may cause you to gain weight or bruise easily. They may cause you to have a fast heartbeat and muscle weakness. Treatment can make your bones brittle and break more easily.
  • You may become weak, tired, and confused if you do not take your medicine. SAI that is not treated can lead to a life-threatening condition called adrenal crisis. Adrenal crisis can make you lose too much fluid, drop your blood pressure, and put you into a coma.

When should I contact my healthcare provider?

  • You have a fever.
  • You have nausea, vomiting, diarrhea, or abdominal pain.
  • You sweat or urinate more than usual.
  • You do not have any more medicine, or you stopped taking it.
  • You have questions or concerns about your condition or care.

When should I seek immediate care or call 911?

  • You always feel dizzy when you stand up.
  • You have very bad pain in your stomach, waist, or back.
  • You have very dry skin, a dry mouth and tongue, or feel very thirsty.
  • Your symptoms become worse, even after you take your medicines.

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 healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. 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.

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