adrenal risk reduction

Overview

Adrenal risk reduction means taking steps to prevent problems with your adrenal glands — two small glands on top of each kidney. These glands make hormones that help your body manage stress, keep blood pressure stable, and balance salt and water. If they do not work properly, even a minor illness can become dangerous. This article explains how to reduce that risk, especially if you have adrenal insufficiency or take long-term steroid medicines.

Adrenal insufficiency is not extremely common, but it affects people of all ages. Adrenal risk reduction is important for anyone with this condition, as well as for anyone who has been on long-term steroid treatment.

It affects people with conditions such as Addison's disease, congenital adrenal hyperplasia, or pituitary gland problems. It also affects people who take long-term steroid medicines for inflammatory or autoimmune conditions like asthma, rheumatoid arthritis, or inflammatory bowel disease.

Symptoms

Common symptoms

• Fatigue and weakness
• Weight loss or poor appetite
• Low blood pressure, especially on standing
• Nausea or vomiting
• Salt craving
• Darkening of the skin, especially on scars or skin folds

Symptoms in children

• Poor growth or slow weight gain
• Frequent infections or illnesses
• Low energy or excessive sleepiness
• Low blood sugar, which can cause shakiness or confusion

Symptoms in older adults

• Confusion or changes in mental state
• Weakness or unsteady walking
• Dizziness or fainting when standing up
• Vague digestive symptoms like nausea or loss of appetite

Causes

Main causes

• Autoimmune disease, where the body's immune system damages the adrenal glands
• Long-term use of steroid medicines, which can suppress the adrenal glands
• Diseases of the pituitary gland, which controls the adrenal glands
• Infections of the adrenal glands, such as tuberculosis or fungal infections
• Surgery or injury to the adrenal glands or the pituitary gland

Risk factors

• Taking steroid medicines for more than 3 weeks
• Stopping steroid medicines suddenly
• Stressful events like surgery, serious infection, or injury
• Not adjusting steroid doses during illness, also called 'sick day rules'

When to see a doctor

See a doctor urgently if:

• If you have signs of an adrenal crisis as listed above
• If you are on steroid medicines and cannot keep them down due to vomiting
• If you have a serious infection, injury, or stress and need advice on extra steroids

Book a routine appointment if:

• If you are feeling unusually tired, weak, or losing weight
• If you have had unexplained low blood pressure or fainting
• If you are on long-term steroids and want to know how to reduce them safely

Diagnosis

Your doctor will ask about your symptoms, medical history, and any medicines you take. Blood tests can measure hormone levels and show whether your adrenal glands respond normally.

Tests that may be done

• Blood cortisol level test
• ACTH stimulation test, which measures how your adrenal glands react to a signal hormone
• Electrolyte and blood glucose tests
• Imaging scans, such as CT or MRI, to look at the adrenal or pituitary glands

What to expect at your appointment

You may be referred to a specialist in hormones, called an endocrinologist. The tests are usually simple and safe. Your doctor will give you clear instructions, including whether you need to stop any medicines before testing.

Treatment

Treatment focuses on replacing the hormones your body needs and teaching you how to prevent a crisis. This is best done with a specialist team who will create a plan tailored to you.

Self-care at home

• Wear a medical ID bracelet or carry an alert card that says 'adrenal insufficiency'.
• Keep an emergency injection kit, if prescribed by your specialist, and know how to use it.
• Learn and follow your 'sick day rules' for increasing your medicine during illness.
• Always carry an extra supply of your steroid medicine and any other prescribed medicines.

Medical treatments

Medical treatment may include steroid replacement therapy, taken daily to imitate your body's natural hormone rhythm. During illness, injury, or stressful events, you may need extra doses. Your healthcare team will teach you exactly how to adjust your medicine. These medicines are personalised — your doctor will determine the right type and dose for you.

When is surgery considered?

If you need surgery, tell your surgical team about your adrenal condition. They will give you extra steroids during and after the operation to keep your body safe.

Living with this condition

Once your condition is stable, you can do almost everything you did before. The key is planning ahead: keep your medicines with you, know when to take extra doses, and make sure family or friends know what to do in an emergency.

Lifestyle tips

• Understand and use your 'sick day rules' for minor illness.
• Never skip or stop your steroid medicine on your own.
• Keep regular follow-up appointments with your specialist.
• Teach a close friend or family member how to recognise the early signs of an adrenal crisis and give an emergency injection if needed.

Diet and exercise

Eat a balanced diet and drink plenty of fluids. Some people need extra salt, especially in hot weather or after intense exercise — but always check with your doctor first. Regular physical activity is encouraged and safe for most people, but rest when you feel tired and build up gradually.

Mental health and emotional wellbeing

Living with a long-term condition can bring anxiety, frustration, or low mood. These feelings are normal and nothing to be ashamed of. Talking to your healthcare team, a counsellor, or a mental health professional can help. If you ever have thoughts of harming yourself, reach out for help immediately — call your local emergency number or a crisis line.

Prevention

Adrenal crisis can often be prevented. You cannot always prevent the underlying adrenal condition, but you can avoid dangerous situations by knowing the warning signs, following your treatment plan, and acting early when you are unwell.

Vaccines

Keep your routine vaccinations up to date, because infections can trigger an adrenal crisis. Talk to your healthcare team about which vaccines are right for you.

Screening programmes

If you have been on long-term steroids, ask your doctor about checking your adrenal function before reducing or stopping them. Screening can help detect problems earlier.

Complications

If left untreated

• Adrenal crisis, a life-threatening emergency
• Severely low blood pressure and shock
• Dangerous electrolyte imbalances, especially high potassium
• Irregular heart rhythms
• In the worst case, death

Long-term outlook

With proper education and care, most people with adrenal insufficiency lead full, active lives. Adrenal crises are largely preventable. Your healthcare team will be your partner in keeping you safe and healthy.

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