Adrenal insufficiency is a medical condition in which the small hormone-producing glands do not make enough steroid hormones such as cortisol.
In plain terms, this disease can sap energy, alter blood pressure and change salt balance in the body. These shifts affect daily wellbeing and can make routine tasks tiring.
This guide is for people with symptoms, those recently diagnosed and carers who need clear, practical advice. It explains what the glands do, how symptoms tend to present and how clinicians confirm the diagnosis in the UK.
There is a key difference between long-term management and urgent episodes. A severe cortisol shortfall can trigger an adrenal crisis — a life-threatening emergency that needs immediate medical care.
The article shows how to recognise red flags, how doctors verify the disease and how treatment is safely adjusted during stress or illness. Readers will find evidence-based, NHS-aligned guidance to support everyday care and emergency planning.
Key Takeaways
- The condition reduces essential hormone production and affects energy, blood pressure and salt balance.
- People with symptoms, newly diagnosed patients and carers should learn day-to-day management and warning signs.
- A sudden severe shortage of cortisol can cause an emergency requiring immediate treatment.
- Diagnosis in the UK follows recognised endocrine practice and clinician-led testing.
- Treatment is lifelong for many, with dose adjustments during illness, stress or surgery.
What adrenal insufficiency is and why adrenal glands matter
Hormone-producing glands sit on top of the kidneys and supply cortisol, aldosterone and androgens that shape energy, blood pressure and wellbeing.
The hormone-producing outer layer
The adrenal cortex is the outer shell that makes steroid hormones. When output falls, energy drops, salt balance shifts and the body struggles to react to stress.
How the brain–gland system works
The hypothalamus releases CRH, the pituitary gland releases ACTH and the cortex makes cortisol. Rising cortisol then feeds back to reduce CRH and ACTH, keeping levels stable.
Types and common causes
- Primary: gland damage (often autoimmune, as in Addison disease) — cortisol and aldosterone fall.
- Secondary: low ACTH from the pituitary — aldosterone usually normal.
- Tertiary: reduced CRH after long-term steroid use; sudden withdrawal can suppress the glands.
| Type | Site of problem | Key hormones affected | Typical causes |
|---|---|---|---|
| Primary | Gland | Cortisol, aldosterone | Autoimmune adrenalitis (Addison disease) |
| Secondary | Pituitary gland | Cortisol | Tumour, surgery, radiation |
| Tertiary | Hypothalamus | Cortisol | Long-term glucocorticoid withdrawal |
“Adrenal fatigue” is not a recognised medical diagnosis; the true condition is rare and needs standard endocrine testing. The next section links this physiology to the everyday symptoms people commonly notice.
For related resources, see clinic procedure examples.
How to recognise adrenal insufficiency symptoms and warning signs
Many signs appear slowly, but a cluster of symptoms should prompt medical review. Early patterns often include persistent tiredness plus reduced strength and unintended weight loss. These changes may be mistaken for stress or routine fatigue.
Everyday clues
Fatigue and muscle weakness often develop gradually. Daily tasks feel harder and recovery after activity is slower.
Loss of appetite, unexplained weight loss and ongoing nausea are common. When these occur together, they signal the need for assessment.
Gut and hydration features
Vomiting, diarrhoea and abdominal pain may follow. Repeated vomiting or diarrhoea causes rapid fluid loss and can lead to dehydration.
Blood pressure and salt balance
Low blood pressure and lightheadedness on standing are important clues. Some people report strong salt cravings when salt balance is disturbed.
Skin and hormonal clues
Darkening of the skin in creases or sun‑exposed areas can point to a primary problem. Women may notice menstrual changes and mood problems such as low mood or irritability.
When symptoms escalate: recognising a crisis
A crisis is a life‑threatening emergency. Key escalation signs include severe vomiting and diarrhoea, marked dehydration, confusion, very low blood pressure and fainting. These signs require immediate urgent care rather than waiting it out.
- Practical checklist: persistent fatigue, progressive muscle weakness, weight loss, recurrent nausea or vomiting, low blood pressure, dizziness, salt craving, skin darkening, mood or menstrual changes.
- Red flags for emergency: severe vomiting/diarrhoea, collapse, confusion, pronounced dehydration, very low blood pressure.
If red flags appear, seek urgent medical help. For related guidance on recognising serious warning signs in other metabolic conditions see related warning signs.
How adrenal insufficiency is diagnosed in the UK
UK clinicians follow a staged pathway: primary care or the acute team orders initial screens, then refers to endocrinology for confirmatory testing and cause finding.
Initial blood tests
Early evaluation includes a morning blood sample to measure baseline cortisol together with electrolytes (sodium and potassium) and glucose. These results show patterns that support a suspected problem.
Confirming the condition
The ACTH stimulation test is the key confirmatory procedure. A baseline sample is taken, synthetic ACTH is given, then cortisol is rechecked. A poor rise suggests a primary gland issue; a normal or subnormal rise points to secondary or tertiary causes.
Finding the cause
Further assays measure basal ACTH, renin and aldosterone to identify a primary pattern and assess salt‑handling risk. These tests guide whether mineralocorticoid replacement is needed.
Imaging when indicated
CT scans examine the adrenal glands for structural disease. MRI targets the pituitary gland when higher‑level causes (tumour, surgery or radiotherapy) are possible.
| Stage | Common tests | Purpose |
|---|---|---|
| Initial | Morning cortisol, electrolytes, glucose | Screen for suggestive patterns |
| Confirmatory | ACTH stimulation test | Localise problem to glands or axis |
| Further | ACTH, renin, aldosterone; CT/MRI | Find cause and plan care |
Safety note: If a crisis is suspected, urgent treatment must not wait for tests. Diagnosis and long‑term treatment should be guided by an endocrinologist to ensure safe, individualised care.
Adrenal insufficiency treatment and how to manage daily life and stress
Treatment aims to restore normal hormone levels so people can maintain daily routines and reduce the risk of an emergency. Doses are individualised to symptoms, activity and clinician monitoring.
Glucocorticoid replacement
All types require glucocorticoid therapy. Common options include hydrocortisone, prednisone and dexamethasone, chosen by the clinician to match lifestyle and response.
Mineralocorticoid replacement
When aldosterone is low, many patients need fludrocortisone to support blood pressure and salt balance. Regular checks of sodium and pressure guide dosing.
Managing stress, surgery and illness
During infection, injury or planned surgery extra glucocorticoid doses (stress dosing) are needed. Patients must follow a written plan from their endocrine team.
Preventing and responding to emergencies
Wear medical ID, carry emergency medication if advised, and ensure family or carers know the plan. If severe symptoms appear, give an immediate injection if trained, call emergency services and attend hospital for urgent care and IV fluids.
NICE guidance (reviewed 18 Dec 2024) supports prevention, consistent care and crisis management across NHS settings.
Conclusion
Timely recognition and a clear plan turn a dangerous emergency into a manageable long‑term condition.
Adrenal insufficiency is rare but serious. The glands and their hormones, especially cortisol and aldosterone, keep energy, blood pressure and salt balance stable.
Primary, secondary and tertiary causes differ in where the problem starts and which hormones fall. Everyday signs include tiredness, low appetite and gut symptoms; severe vomiting, collapse or confusion signal an emergency.
UK diagnosis uses morning bloods, the ACTH stimulation test, targeted hormone assays and imaging when needed. Treatment works well when taken correctly and with stress dosing for illness or surgery.
Prevention priorities are clear: wear medical ID, carry an emergency plan, seek urgent care for collapse or severe dehydration, and arrange specialist follow‑up if concerns persist.
