Understanding Adrenal Insufficiency and Addison’s Disease
Adrenal insufficiency and Addison’s disease are intimately related disorders that are sometimes confused with one another. While Addison’s disease is indeed a type of adrenal insufficiency, it’s also extremely rare. In fact, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) estimates that only 100 to 140 out of every million people in developed countries have the disease. By contrast, other forms of adrenal insufficiency may affect twice that many individuals.
In this article, we’re going to discuss the similarities of these medical conditions—as well as their differences—and uncover what you need to know if you’re suffering from adrenal insufficiency or Addison’s disease.
What Is Adrenal Insufficiency?
Adrenal insufficiency occurs due to a disruption in hormone production by the adrenal glands. The adrenal glands are small, triangular-shaped glands that sit on top of both kidneys. Each is composed of an outer layer called the adrenal cortex and an inner layer called the adrenal medulla. The adrenal glands are part of the endocrine system and produce many of the hormones that contribute to our well-being and survival.
The adrenal cortex produces steroid hormones, including aldosterone, which helps regulate blood pressure and electrolyte balance; cortisol, which helps regulate metabolism, immune system function, and blood sugar levels; and androgens, which are used to make sex hormones.
The adrenal medulla produces the catecholamines—including adrenaline and noradrenaline—which are required by the body during times of stress and are responsible for fueling the fight-or-flight response.
If levels of these hormones aren’t sufficient to meet the body’s demands, primary, secondary, or tertiary adrenal insufficiency may result:
- Primary adrenal insufficiency: This type of adrenal insufficiency occurs as a result of damage to the adrenal glands.
- Secondary adrenal insufficiency: This type of adrenal insufficiency begins in the pituitary gland, which is responsible for secretion of adrenocorticotropic hormone (ACTH). Because ACTH is used to signal the adrenal glands to produce cortisol, disruption in ACTH secretion can lead to low cortisol levels.
- Tertiary adrenal insufficiency: This type of adrenal insufficiency starts in the hypothalamus and is the result of impaired corticotropin-releasing hormone (CRH) secretion. This type is known as tertiary adrenal insufficiency because CRH tells the pituitary to make ACTH, which in turn tells the adrenal glands to make cortisol.
What Causes Addison’s Disease?
Addison’s disease is often called primary adrenal insufficiency since the condition occurs as a result of damage to the adrenal glands. This damage leads to reduced cortisol production and sometimes reduced aldosterone production as well.
Because cortisol helps modulate the body’s immune system—helping it respond appropriately and then back off before it causes harm to the body itself—anything that leads to a disruption in cortisol production can cause levels of inflammation to rise unchecked.
And unchecked inflammation is the hallmark of autoimmune diseases, so it should come as no surprise that autoimmune disorders are the most common cause of damage to the adrenal glands. However, other medical conditions can also lead to primary adrenal insufficiency. These other causes include:
- Fungal infections
- Human immunodeficiency virus (HIV)
- Metastasis to the adrenal glands
- Bleeding into the adrenal glands
- Congenital anomalies of the adrenal glands
Symptoms of Adrenal Insufficiency
All types of adrenal insufficiency share similar symptoms. Some of the more common symptoms seen with adrenal insufficiency include:
|Chronic fatigue||Muscle weakness|
|Weight loss||Loss of appetite|
|Abdominal pain||Nausea, vomiting, or diarrhea|
|Low blood pressure||Mood swings|
|Salty food cravings||Low blood sugar|
|Muscle and joint pain||Irregular menstrual periods|
However, primary adrenal insufficiency may present with one other specific symptom as well: hyperpigmentation of the skin and mucous membranes.
Moreover, symptoms of Addison’s disease may suddenly become quite severe, usually as a result of increased stress due to injury or illness. This acute adrenal insufficiency, or Addisonian crisis, results in extremely low blood pressure and blood sugar and high potassium levels and can lead to shock, seizure, coma, or even death.
Additional symptoms of an adrenal crisis may include:
- Severe vomiting and diarrhea
- Loss of consciousness
- High fever
- Rapid breathing and heart rate
Diagnosing Adrenal Insufficiency
To diagnose adrenal insufficiency, your health care provider will first speak with you about your symptoms and then perform a series of tests. These include:
- Blood tests: These tests are used to evaluate levels of sodium, potassium, cortisol, ACTH, and antibodies related to Addison’s disease.
- ACTH stimulation test: This test involves measuring cortisol levels both before and after injecting a synthetic form of ACTH.
- Insulin-induced hypoglycemia test: This insulin tolerance test measures blood sugar and cortisol levels after an injection of insulin. If blood sugar levels fail to fall and cortisol levels fail to rise, a diagnosis of secondary adrenal insufficiency is indicated.
- Imaging: Computed tomography (CT) and magnetic resonance imaging (MRI) scans may be used to look for abnormalities involving the pituitary or adrenal glands.
Treating Adrenal Insufficiency
Because adrenal insufficiency results from low levels of steroid hormones, treatment of the condition involves using hormone replacement therapy to compensate. In individuals with low levels of cortisol, corticosteroids such as hydrocortisone and prednisone are prescribed. People with low levels of aldosterone may be prescribed fludrocortisone acetate as well.
While some individuals are wary of the side effects generally associated with steroids, it’s important to remember that the dose prescribed is intended to replace only what’s missing, so these adverse effects shouldn’t occur. However, the dose needed to treat adrenal insufficiency may fluctuate over time, so you should follow closely with your health care provider.
Moreover, during periods of increased stress—such as that seen after surgery or during an illness—the dosage of hormones may need to be adjusted upward until the situation has passed. And in people who are experiencing an Addisonian crisis, intravenous medications will be needed.
Individuals with adrenal insufficiency may also be asked to increase their salt intake, especially during hot weather and strenuous exercise, as low levels of aldosterone can lead to loss of salt.
Adrenal Insufficiency and Amino Acid Therapy
Amino acids are organic compounds that join together to form proteins. While the body creates some of these building blocks of life on its own, the so-called essential amino acids must be obtained through food. Amino acids are necessary for almost every biological process, so it’s not surprising that the adrenal glands need them to function properly.
For example, cortisol regulates the synthesis of phenylethanolamine N-methyltransferase, an enzyme that in turn controls the synthesis of epinephrine and norepinephrine in the adrenal glands. However, increasing the amount of cortisol in the body won’t necessarily resolve all the symptoms of adrenal insufficiency.
So if you want to truly optimize adrenal function, you may need to take a more comprehensive treatment approach that includes a carefully balanced supply of amino acids.
In addition, a growing number of experts believe that more and more people are living with a condition called adrenal fatigue, which is often linked to stress. And because amino acids such as L-theanine encourage the release of gamma-aminobutyric acid (GABA)—which in turn promotes the release of calming neurotransmitters like dopamine and serotonin—they may be able to reduce the stress that’s implicated in the development of adrenal fatigue.
If you’re experiencing symptoms of adrenal fatigue or insufficiency and are interested in learning how amino acids can help you reclaim your health, be sure to look for a balanced formula that includes a synergistic blend of all essential amino acids.
And don’t forget that adrenal insufficiency is a serious medical condition that can lead to potentially life-threatening complications if not appropriately treated, so make sure to include your health care provider in all your treatment decisions.