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Secondary Adrenal Insufficiency

Medically reviewed by Last updated on Mar 5, 2023.

What is secondary adrenal insufficiency (SAI)?

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.

What causes secondary adrenal insufficiency?

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

  • Loss of a large amount of blood during or after childbirth that damages the pituitary gland
  • Certain diseases and infections
  • Certain medicines, or long-term treatment with steroid medicines for other conditions
  • Suddenly stopping steroid medicines
  • Radiation treatment on your head that damages your brain and pituitary gland
  • Surgery, direct trauma, or injury that causes bleeding and damage to your pituitary gland
  • Blood clots in your brain that puts pressure on your pituitary gland and damages it
  • Certain brain and pituitary gland tumors, or tumors from other organs that spread to the brain

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 or she may ask about your medical history. You may also need any of the following:

  • Blood tests are used to measure hormone levels and to check for health problems SAI may be causing.
  • Urine tests are used to check the amount of adrenal hormones in your urine.
  • Chemical stimulation tests are used to check for an increase in hormone levels. Your blood is tested 2 times. First 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.
  • CT scan or MRI pictures of your brain and adrenal glands may be used to see why you have SAI. They can show cancers, infection, or any abnormal bleeding. You may be given contrast liquid to help your brain and adrenal glands show up better in the pictures. Tell the provider if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the provider if you have any metal in or on your body.

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 provider will order medicine that can be given as a shot if you have an adrenal crisis. Ask your 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 provider. You can trigger an adrenal crisis if you stop taking steroids suddenly.

Treatment options

The following list of medications are in some way related to or used in the treatment of this condition.

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What do I need to know about an adrenal crisis?

An adrenal crisis happens when your cortisol and aldosterone levels suddenly drop. This may lead to low blood pressure, dehydration, and low blood sugar. An adrenal crisis is life-threatening and needs immediate treatment in a hospital. You will be given steroids and glucose (sugar). You may be given sodium (salt) and medicine to increase your blood pressure. You may also need IV fluids to treat dehydration. An adrenal crisis can happen if you suddenly stop taking your medicine. It can also happen when your body is under more stress than usual. This may happen during surgery, an illness, or trauma.

When should I seek immediate care?

  • You always feel dizzy when you stand.
  • You have severe 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.

When should I call my doctor?

  • You have a fever.
  • You have nausea, diarrhea, or abdominal pain, or you are vomiting.
  • You sweat or urinate more than usual.
  • You stopped taking your medicine.
  • You have questions or concerns about your condition or care.

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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