Adrenal insufficiency · Addison's disease
Addison's disease and adrenal insufficiency, managed with confidence.
When the adrenal glands cannot make enough cortisol, everyday stress and illness become risky. With the right replacement and a clear plan, people live full, active lives.
Three ways it happens
Cortisol helps regulate blood pressure, blood sugar and the body's response to stress. Adrenal insufficiency means too little of it.
Primary (Addison's disease)
The adrenal glands themselves are damaged, most often by autoimmunity. Aldosterone, which keeps salt and potassium in balance, is usually low too.
Secondary
The pituitary gland does not send enough ACTH, the signal that tells the adrenals to make cortisol.
After steroid medicines
Months of prednisone or similar drugs can switch off the body's own cortisol production. Stopping them suddenly can be dangerous.
Symptoms
Symptoms tend to build slowly and are easy to blame on something else:
- Fatigue, weakness and low stamina
- Poor appetite, weight loss, nausea or abdominal pain
- Dizziness on standing, or low blood pressure
- Salt craving and darkening of the skin, gums or scars (primary disease)
- Low blood sugar, especially with illness or missed meals
Adrenal crisis is an emergency. Severe vomiting, confusion, very low blood pressure or collapse in someone with known or suspected adrenal insufficiency needs injectable hydrocortisone and a call to 911.
Diagnosis
An early-morning cortisol with ACTH is the usual first step. When results are borderline, a cosyntropin (ACTH) stimulation test measures how well the adrenals respond. Renin and aldosterone show whether salt balance is affected, and adrenal antibodies help confirm autoimmune Addison's disease. For secondary disease, the pituitary is evaluated as well.
Treatment and daily life
- Cortisol replacement, usually hydrocortisone in two or three daily doses, set at the lowest dose that keeps you well
- Fludrocortisone for primary disease, to replace aldosterone and steady blood pressure
- Sick-day rules: with a fever, the daily dose is typically doubled, and tripled for a higher fever, until you recover
- An emergency injection kit and a medical ID, so others know what to do
- A gradual taper for steroid-related insufficiency, with testing to confirm recovery
Dr. Hasan is experienced in diagnosing and managing adrenal insufficiency, including steroid tapers, dose adjustments and individualized sick-day plans. Adrenal and pituitary disorders are a particular focus of his practice.
Common questions
Is adrenal insufficiency lifelong?
Addison's disease is lifelong. Insufficiency caused by steroid medicines often recovers over months as the dose is tapered, and a stimulation test confirms when it has.
Can I exercise and travel normally?
Yes. With the right replacement dose, most people work, exercise and travel freely. Carry extra tablets and your emergency kit when away from home.
Is "adrenal fatigue" the same thing?
No. Adrenal fatigue is not a recognized medical diagnosis. True adrenal insufficiency is confirmed with blood tests, and taking cortisol when it is not needed can cause harm.
Do I need to adjust my dose for surgery?
Yes. Procedures and surgery require extra steroid coverage. Let your surgical team know, and Dr. Hasan can provide specific instructions.
Related conditions
In Wexford or by telehealth in PA and OH