Adrenal insufficiency: what to watch for and what to do

Feeling tired all the time, losing weight without trying, or fainting when you stand up? Those are common red flags for adrenal insufficiency. This page gives you quick, practical info: how doctors test for it, the usual treatments, and the exact things you should do during illness or emergency.

Signs, causes, and differences you can spot

Symptoms include constant fatigue, muscle weakness, low blood pressure, dizziness on standing, salt cravings, weight loss, and stomach pain. If you see dark patches on your skin (especially in mouth or scars) plus low sodium and high potassium on blood tests, that points to primary adrenal failure—Addison's disease. Secondary adrenal insufficiency comes from low ACTH production in the pituitary and usually lacks skin darkening or high potassium.

Common causes: autoimmune destruction of the adrenal glands, infections like TB in some areas, pituitary problems, or long-term steroid use that stops your own hormones from being made. If you've recently tapered off steroids after a long course, watch for symptoms closely.

How doctors check for it—and what the numbers mean

Your clinician will often start with a morning (8 AM) serum cortisol. A very low morning cortisol (for example under ~3 µg/dL) strongly suggests adrenal insufficiency, while a high morning cortisol usually rules it out. The ACTH (cosyntropin) stimulation test is the standard follow-up: cortisol is measured before and after a synthetic ACTH injection; failure to rise above about 18–20 µg/dL indicates inadequate adrenal response.

Blood ACTH helps tell primary from secondary: high ACTH means the problem is in the adrenal glands; low or normal ACTH suggests a pituitary cause. Doctors may also check electrolytes—sodium and potassium—and order imaging (CT or MRI) if needed.

Treatment is straightforward but essential. Glucocorticoid replacement—usually hydrocortisone—is the mainstay. Typical daily doses run around 15–25 mg in divided doses (for example 10 mg on waking, 5 mg midday, 2.5–5 mg late afternoon). Some people use prednisone instead; your doctor will advise. If aldosterone is also low (common in primary disease), fludrocortisone 0.05–0.2 mg daily replaces salt-regulating hormone.

Practical safety rules: always carry a steroid card or wear a medical ID, keep an emergency injection kit (intramuscular hydrocortisone) if your doctor prescribes one, and increase glucocorticoid dose during fever, vomiting, surgery, or major stress—typically double or triple your usual dose until you recover. Learn how and when to use the emergency injection; it can prevent an adrenal crisis, which is life-threatening.

Follow up regularly with an endocrinologist to adjust dosing, review blood pressure and electrolytes, and talk about bone health and vaccines. If you faint, feel severely weak, have severe abdominal pain, or can't keep oral medication down, seek emergency care right away and tell staff you have adrenal insufficiency.

If you want, I can help summarize recommended items for a steroid emergency kit, sample sick-day dosing, or questions to bring to your endocrine visit.