Children's Hospital Colorado
ENDOCRINOLOGY

Adrenal Insufficiency

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What is adrenal insufficiency?

Adrenal insufficiency is a condition in which the adrenal glands do not make enough hormones. The adrenal glands make cortisol, aldosterone and androgen (testosterone-like) hormones.

  • Cortisol is a steroid hormone that is important for managing blood pressure, blood sugar and energy. In times of illness, it is a life-saving hormone.
  • Aldosterone is a hormone that helps manage the body’s blood pressure by keeping the body’s salt and water in a normal range. Without aldosterone, the kidney loses too much salt and water and holds onto too much potassium. This causes low blood pressure and high potassium levels in the blood.
  • Androgens are male sex hormones that are important for growth and puberty.

What causes adrenal insufficiency?

Adrenal insufficiency can be “primary,” which involves lower amounts of the cortisol and aldosterone hormones. It can also be “secondary,” which involves lower amounts of the cortisol hormone.

  • Primary adrenal insufficiency is caused by damage to the adrenal gland, which is sometimes from an autoimmune disorder called Addison’s disease. An autoimmune disorder is when the body’s infection-fighting proteins accidentally fight and kill its own cells – in this case, adrenal cells. Other causes are infection, cancer and bleeding in the adrenal glands. Congenital adrenal hyperplasia is another form of adrenal insufficiency. Primary adrenal insufficiency most often decreases the amount of cortisol and aldosterone.
  • Secondary adrenal insufficiency is caused by a problem with the pituitary gland. The pituitary is a small gland in the brain. It makes a hormone called adrenocorticotropic hormone (ACTH), which tells the adrenal gland to make the cortisol hormone. If the pituitary is not working, the adrenal glands will not make cortisol. This can be caused by abnormal pituitary growth, brain injury, infection or cancer.

A special form of secondary adrenal insufficiency can happen when a person takes steroid medicines for a long time as a treatment for another disorder like asthma or arthritis. Because the pituitary senses that there is already a lot of cortisol hormone in the body, it does not tell the adrenal glands to make cortisol. After a time, the adrenal gland will become smaller and less able to make cortisol. If steroid treatments are suddenly stopped, the adrenal glands don't have enough time to rebound and make cortisol. Without cortisol, the body can become sick. This type of secondary adrenal insufficiency can be treated by slowly reducing steroid medicine and providing higher doses during times of illness to mimic what the body would typically do on its own when it is stressed.

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