long lasting adrenal

Overview

Long-lasting adrenal insufficiency is a condition where the adrenal glands—two small glands that sit on top of your kidneys—do not make enough of certain hormones, especially cortisol. Cortisol helps your body handle stress, keep blood pressure normal, and maintain your energy.

No, long-lasting adrenal insufficiency is rare. It affects roughly 1 in every 10,000 to 20,000 people around the world.

It can affect people at any age, but it is most often diagnosed in adults between 30 and 50 years old. It may also appear in children and older adults.

Symptoms

Common symptoms

• Feeling very tired or weak much of the time
• Unintentional weight loss
• Low blood pressure and dizziness when standing up
• Darkening of the skin, especially in creases and scars
• Strong cravings for salt
• Changes in mood, such as feeling sad or irritable
• Nausea, stomach pain, or occasional vomiting

Symptoms in children

• Poor growth or slow weight gain
• Extreme tiredness
• Low blood sugar, which can cause shakiness or confusion
• Dark lines or patches on the skin, gums, or inside the cheeks
• Stomach pain or vomiting

Symptoms in older adults

• Confusion or memory problems
• Falls due to low blood pressure
• Severe fatigue and muscle weakness
• Loss of appetite and unintended weight loss
• Low body temperature or feeling cold all the time

Causes

Main causes

• Autoimmune damage: the body's immune system mistakenly attacks the adrenal glands
• Infections of the adrenal glands, such as tuberculosis
• Bleeding or reduced blood flow to the adrenal glands
• Surgical removal of the adrenal glands
• Certain genetic conditions that affect hormone production

Risk factors

• Having another autoimmune condition, such as type 1 diabetes, thyroid disease, or vitiligo
• Taking long-term steroid medicines and then stopping suddenly
• Having a family history of adrenal or autoimmune disorders
• Having had severe infections or injuries that affect the adrenal glands

When to see a doctor

See a doctor urgently if:

• If you have symptoms of an adrenal crisis, such as fainting, very low blood pressure, or severe vomiting, call your local emergency number now.
• If you know you have adrenal insufficiency and you become ill, especially with fever, vomiting, or diarrhea, seek urgent medical care the same day.

Book a routine appointment if:

• If you have been feeling unusually tired, losing weight, or feeling sick without a clear reason, make an appointment with your doctor.
• If you have skin darkening and are not sure why, talk to your doctor during your next visit.

Diagnosis

Your doctor will ask about your symptoms, do a physical exam, and order blood tests to check your hormone levels. A short acth stimulation test is used to see how your adrenal glands respond to a signal from the brain.

Tests that may be done

• Blood test to measure cortisol in the morning
• Adrenocorticotropic hormone (ACTH) stimulation test
• Blood test to check sodium, potassium, and blood sugar
• Imaging scans like a CT scan of the adrenal glands, if needed

What to expect at your appointment

These tests are usually done in a clinic or hospital. You may be asked to fast or stop certain medications beforehand. Your doctor will explain exactly what to do. The tests are safe and relatively simple.

Treatment

Treatment focuses on replacing the hormones your adrenal glands are not making enough of. You will work with your doctor to find the right type and amount of hormone replacement for your body. You will also learn how to adjust your medication during stress, illness, or emergencies.

Self-care at home

• Take your hormone replacement medicine exactly as prescribed, every day.
• Wear a medical alert bracelet or necklace that says you have adrenal insufficiency.
• Carry an emergency kit with extra medicine, as recommended by your doctor.
• Learn how to increase your medicine dose when you are sick or stressed, under your doctor's guidance.

Medical treatments

Doctors typically prescribe steroid replacement therapy—such as hydrocortisone or fludrocortisone—to replace the missing cortisol and aldosterone. The dose is individual and may need to change during infection, surgery, or injury. In emergency situations, you may be taught to give yourself an injectable form of this medicine.

When is surgery considered?

Surgery is not a common treatment for adrenal insufficiency itself. However, if the adrenal glands are damaged by a tumor or other problem, surgery may be part of the overall care plan. Your doctor will discuss this if it applies to you.

Living with this condition

Living with long-lasting adrenal insufficiency means making room for daily medication and being aware of your body's signals. Many people find a routine that works well and allows them to work, travel, and enjoy life. The key is preparation—keep a supply of medicine with you, know when to take extra doses, and make sure close friends or family know what to do in an emergency.

Lifestyle tips

• Wear a medical alert ID at all times.
• Keep an emergency supply of your medicine at work, in your bag, or at school.
• Tell your healthcare team about your condition before any planned surgery or dental procedure.
• Avoid stress when you can, but know how to manage stress when it happens.
• Have regular check-ups with your doctor to adjust your medicine if needed.

Diet and exercise

Eat a balanced diet that includes enough salt—especially in hot weather or during intense exercise, since your body loses salt. Light to moderate exercise like walking or swimming can boost your energy. Listen to your body and rest when you need to.

Mental health and emotional wellbeing

Dealing with a chronic illness can be stressful and sometimes overwhelming. It is normal to feel anxious, frustrated, or low at times. Talking with a counsellor, psychologist, or your doctor can help. Remember that you are not alone, and support is available.

Prevention

In most cases, long-lasting adrenal insufficiency cannot be prevented because it often results from an autoimmune reaction or other health problem. However, if you use steroids long-term, you can reduce your risk by working with your doctor to taper off slowly and never stopping suddenly.

Vaccines

Staying up to date on vaccinations, especially for flu, pneumonia, and COVID-19, is important because infections can trigger an adrenal crisis. Talk to your doctor about which vaccines are recommended for you.

Screening programmes

There is no routine screening for the general public. But if you have a family history of autoimmune disease or unexplained symptoms, your doctor may suggest testing your cortisol levels as part of a check-up.

Complications

If left untreated

• Adrenal crisis, a life-threatening emergency where blood pressure drops dangerously and the body cannot cope
• Severe low blood sugar, which can cause confusion, seizures, or loss of consciousness
• Low blood sodium, which can lead to brain swelling and confusion
• Extremely low energy and inability to do daily tasks

Long-term outlook

With early diagnosis and consistent treatment, the outlook is very good. Most people with long-lasting adrenal insufficiency can live full, productive lives. It does require daily attention and a strong partnership with your healthcare team, but you can stay active and healthy.

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