Adrenal Insufficiency

February 1, 2017

Adrenal insufficiency, also known as Addison’s disease, is a rare endocrine, or hormonal disorder that affects 1 in 10,000 people.It occurs in all age groups and afflicts men and women equally. It occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases, the hormone aldosterone. Hence, the disease is sometimes called chronic adrenal insufficiency, or hypocortisolism.

What are Adrenal Glands?

The adrenal glands are located at the top of the kidneys, one on each side of the body. It produces the steroid hormones that are essential for life; cortisol and aldosterone. Cortisol mobilizes nutrients, enables the body to fight inflammation, stimulates the liver to produce blood sugar and also helps control the amount of water in the body. Aldosterone regulates salt and water levels which affect blood volume and blood pressure.The adrenal glands also produce sex hormones known as adrenal androgens; the most important of these is a hormone called DHEA.

Adrenal Insufficiency is caused by failure of the adrenal glands to produce sufficient or any amount of cortisol and aldosterone. Prolonged lack ofcortisol leads to severe fatigue, chronicexhaustion, depression, loss of appetiteand weight loss. Lack of aldosteroneleads to a drop in blood pressure.Loss of DHEA production bythe adrenals results in loss of hair in pubic and underarm areas and also potentially reduced sex drive and low energy levels in women affected by adrenal insufficiency. A specific dark pigmentation of the skin is also sometimes observed, particularly in areas where the clothes rub against the skin and in areas exposed to increased xrddi98ck8riction, such as the creases of the

Cortisol is important for life and its production by the adrenal glands is especial\llyimportant at times when the body experiences intense ‘stress’, such as surgery, trauma or serious infection. If the adrenal glands cannot produce enough cortisol, the body might not be able to cope with this kind of major stress, which can be life-threatening.

Types of Adrenal Insufficiency

  • Primary insufficiency (Addison’s disease) – There is an inability of the adrenal glands to produce enough steroid hormones. The most common cause for this in the developed world is autoimmune disease.
  • Secondary insufficiency – there is inadequate pituitary or hypothalamic stimulation of the adrenal glands.



Adrenal Insufficiency is most often caused by autoimmune disease where the body’s immune system mounts an attack against its own adrenal cells. However, it can also be caused by infection, most importantly by tuberculosis. Sometimes both adrenal glands are surgically removed for various reasons; this is called a bilateral adrenalectomy and is another cause of primary adrenal insufficiency.

  • Autoimmune Factor – Up to 80 percent of Adrenal insufficiency cases are caused by an autoimmune disorder, which is when the body’s immune system attacks the body’s own cells and organs. In autoimmune Addison’s, which mainly occurs in middle-aged females, the immune system gradually destroys the adrenal cortex—the outer layer of the adrenal glands.
  • Genetic Factor – The inborn causes of adrenal insufficiency which are caused by spelling errorsin the genetic code. This includes the disruption of hormone production in the adrenals by different variants of congenital adrenal hyperplasia (CAH). In CAH, there is a spelling error in the gene responsible for the production of the protein that helps to generate cortisol in the adrenal; as a result cortisol and often also aldosterone levels are low. Another inborn cause of adrenal insufficiency is a condition called X-linked adrenoleukodystophy (ALD) or adrenomyeloneuropathy (AMN) that affects boys and men and can cause both adrenal insufficiency and neurological symptoms.
  • Infections – Tuberculosis (TB), an infection that can destroy the adrenal glands, accounts for 10 to 15 percent of adrenal insufficiency cases in developed countries. When primary adrenal insufficiency was first identified by Dr. Thomas Addison in 1849, TB was the most common cause of the disease.
  • Other Causes –Less common causes of Addison’s disease are
    • Cancer cells in the adrenal glands
    • Amyloidosis, a serious, though rare, group of diseases that occurs when abnormal proteins, called amyloids, build up in the blood and are deposited in tissues and organs
    • Surgical removal of the adrenal glands
    • Bleeding into the adrenal glands
    • Medication-related causes, such as from anti-fungal medications and the anesthetic etomidate, which may be used when a person undergoes an emergency intubation—the placement of a flexible, plastic tube through the mouth and into the trachea, or windpipe, to assist with breathing.

Pituitary Gland and Adrenal Insufficiency – Another important cause of adrenal insufficiency is disease affecting the pituitary gland, an endocrine gland located behind the nose at the bottom of the brain.

Environmental Factors

  • Nutritional Deficiencies are a common cause. The need for nutrients is much greater during Adrenal insufficiency. Carbohydrates, when excessive in the diet, stress the adrenals. Diets low in protein may also create deficiencies. Inadequate or poor quality water affects oxygenation of the tissues. Most diets are low in nutrients required by the adrenals. These include B-complex vitamins, vitamins A, C and E, manganese, zinc, chromium, selenium and other trace elements. The reasons for this begin with how food is grown. Most food is grown on depleted soils. Processing and refining further deplete nutrients. Habits such as eating in the car or while on the run further diminish the value derived from food. Also, allergic reactions to foods such as wheat and dairy products can damage the intestines and reduce the absorption of nutrients.
  • Toxic metals and chemicals often play a large role in adrenal burnout. Everyone is exposed to thousands of chemicals in the air, the water and the food. Other sources are dental materials and skin contact with chemicals. Over-the-counter and prescribed medications add to the body’s toxic load. Most people do not realize that antibiotics and many other drugs accumulate to some extent in the liver and other organs. Toxins may also be generated within the body due to impaired digestion. When food is not properly digested, it either ferments or rots in the intestines, producing many harmful substances that are absorbed into the body. A healthy body has the ability to eliminate many toxins on a daily basis. However, as adrenal weakness develops the body’s ability to eliminate all toxins decreases. This produces a vicious cycle in which weaker adrenals impairs the elimination of all poisons, which then further weakens the adrenals.
  • Stimulants damage the adrenal glands. They whip the adrenals. Caffeine, sugar and alcohol are among the most common stimulants.


The most common symptoms of adrenal insufficiency are

  • Chronic, or long lasting, fatigue
  • Muscle weakness
  • Loss of appetite
  • Weight loss
  • Abdominal pain

Other symptoms of adrenal insufficiency can include

  • Nausea
  • Vomiting
  • Diarrhea
  • Low blood pressure that drops further when a person stands up, causing dizziness or fainting
  • Irritability and depression
  • Craving salty foods
  • Hypoglycemia, or low blood sugar
  • Headache
  • Sweating
  • Irregular or absent menstrual periods
  • In women, loss of interest in sex
  • Hyperpigmentation, or darkening of the skin

Adrenal Crisis

Sudden, severe worsening of adrenal insufficiency symptoms is called adrenal crisis. If the person has adrenal insufficiency. In most cases, symptoms of adrenal insufficiency become serious enough that people seek medical treatment before an adrenal crisis occurs. However, sometimes symptoms appear for the first time during an adrenal crisis. Symptoms of adrenal crisis include –

  • Sudden, severe pain in the lower back, abdomen, or legs
  • Severe vomiting and diarrhea
  • Dehydration
  • Low blood pressure
  • Loss of consciousness

If not treated, an adrenal crisis can cause death.


Conventional –

  • Adrenal insufficiency is treated by replacing, or substituting, the hormones that the adrenal glands are not making. The dose of each medication is adjusted to meet the needs of the patient.
  • Cortisol is replaced with a corticosteroid, such as hydrocortisone, prednisone, or dexamethasone, taken orally one to three times each day, depending on which medication is chosen.
  • If aldosterone is also deficient, it is replaced with oral doses of a mineralocorticoid hormone, called fludrocortisone acetate (Florinef).
  • Standard therapy involves immediate IV injections of corticosteroids and large volumes of IV saline solution with dextrose, a type of sugar, in cases of adrenal crisis that involves – low blood pressure, low blood glucose, low blood sodium, and high blood levels of potassium can be life threatening.
  • Replacement therapy for DHEA in adolescent girls who have secondary adrenal insufficiency and low levels of DHEA can improve pubic hair development and psychological stress.

Alternative Treatment

  • Vitamins & Minerals – There are a number of vitamins and minerals that Adrenal insufficiency sufferers tend to be lacking.There are other valuable supplements (vitamin D, vitamin E and others) but I will keep this section as simple as possible. It is important to note that not all of these will be appropriate for each individual.
  • Vitamin B12, B6 and B5 – These important B vitamins play an important role in cell metabolism. Improving your metabolic pathways boosts your energy levels and is a great way to reduce the fatigue often felt during AI. B5 helps to produce co-enzyme A, which contributes to cellular respiration and the breakdown of fats, proteins and carbohydrates. B6 acts in several of the pathways that are used to create adrenal hormones. And B12 helps with energy production, cell repair and the maintenance of our red blood cells.
  • Vitamin C – This powerful antioxidant vitamin is directly involved in the production of cortisol in your adrenals. So besides the other health benefits it carries (boosting your immune system, protecting from free radicals), vitamin C is also an essential building block for the recovery of your adrenal glands.
  • Magnesium – Studies suggest that 75% of Americans are deficient in magnesium. In very simple terms, magnesium helps to maintain energy flow, so you can see that deficiency might be a problem.
  • Probiotic -By improving the digestion, probiotics enable the body to extract more of the nutrients present in the foods that is eaten. This allows the body to get more of the essential vitamins and minerals that are needed to maintain the energy levels and produce the hormones that aree needed. Additionally, they support the immune system and prevent regular illness from weakening our adrenals further.
  • Licorice Root – This is an herb that has long been used to stimulate hormone production, maintain energy levels and increase endurance. It is a great choice for many individuals with AI, as it helps the cortisol to circulate for longer, but there is one significant drawback.
  • Maca Root – Research has shown maca to have beneficial effects on cortisol regulation and blood sugar. It also allows for more efficient uptake of hormones into the cells, increasing their effectiveness. If somone suffers from Adrenal Insufficiency and have low hormone levels, maca helps the body to make the most of those low hormone levels.
  • Omega 3 – Most of the people are deficient in Omega-3 fatty acids, although the body tends to have an adequate supply of Omega-6. This imbalance can lead to increased inflammation, which requires an increase in cortisol production to manage. Taking a good Omega-3 supplement can reduce inflammation throughout the body and relieve the workload placed on your adrenals.
  • Acetyl–L–Carnitine – This supplement is particularly useful for boosting metabolism and increasing energy levels. Acetyl-L-Carnitine increases the production of certain neurotransmitters in which people are often deficient, and it helps to move fatty acids into the mitochondria where the body needs them to produce energy.
  • CoQ10 – The body produces CoQ10 and uses it to produce energy for growing and maintaining the cells. Some find that it increases endurance and improves recovery time after exercise. Good food sources include beef, sardines and various organ meats, but if you are not getting enough from food then supplementation might be an excellent choice.
  • DRibrose – This supplement is another way to sustain higher energy levels throughout the day without placing any stress on your adrenal glands. D-Ribose is actually a form of sugar, but it won’t spike the blood sugar like glucose or other sweeteners. Instead, it goes directly to forming ATP, the molecule that facilitates the transfer of energy between the cells. Tissues in the heart and muscles respond particularly well to D-Ribose supplementation, and many AI sufferers find it gives a useful boost to their energy levels.
  • Ashwagandha-Known as an adaptogenic herb, ashwagandha regulates various systems in the body. If cortisol is too high, it acts to lower it, And if cortisol is too low, it acts to raise it.


Reference –

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