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Secondary Adrenal Insufficiency is a serious and life-threatening illness often caused when the Pituitary gland in the brain fails to send sufficient amounts of the hormone ACTH to the Adrenal glands. This results in insufficient amounts of cortisol being released into the bloodstream and can lead to low cortisol symptoms and adrenal crisis. 

Secondary Adrenal Insufficiency symptoms

What You Need To Know About Secondary Adrenal Insufficiency

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Being diagnosed with Adrenal insufficiency can be a scary and life-changing experience.  Today I am sharing 15 facts about Secondary Adrenal Insufficiency to help you better understand the illness and how it affects those suffering from Adrenal Insufficiency symptoms.

There is a lot to learn about Secondary Adrenal Insufficiency and whether you’re a patient, a doctor or a medical professional, it is important to understand the cause of the condition.  This includes how dangerous it can be and how to treat a patient on a daily basis and during an adrenal crisis or medical emergency

These facts are important for the following people:

  • A newly diagnosed patient of secondary insufficiency
  • Parents of infants and children with secondary insufficiency
  • Endocrinologists
  • Medical professionals dealing with Secondary AI patients
  • Surgeons operating on someone with Secondary Adrenal Insufficiency
  • Ambulance and Medical Emergency staff
  • Dentists who perform fillings and dental treatment
  • Your local GP or Doctor
  • Family members of patients with Adrenal Insufficiency
  • School staff of a child diagnosed with secondary adrenal insufficiency

The list goes on. It is very important for all to understand this serious condition as knowledge can help manage low cortisol and prevent unnecessary death.

What Is Secondary Adrenal Insufficiency?

Secondary Adrenal Insufficiency is just as life-threatening as Primary Adrenal Insufficiency known as Addison’s Disease.  Secondary Adrenal Insufficiency is not Addison’s Disease. Addison’s Disease is when the Adrenal glands cannot function properly due to the adrenal glands failing to work directly. 

Secondary Adrenal Insufficiency is due to a lack of ACTH being produced in the Pituitary, a small part in the brain and this pituitary problem results in a secondary problem in the adrenals being the life-threatening condition of insufficient Cortisol production.

Secondary Adrenal Insufficiency Symptoms

Some of the major Secondary Adrenal Insufficiency symptoms include severe fatigue and weakness, ongoing exhaustion, loss of appetite, weight loss, nausea, vomiting, painful muscles and joints, diarrhea, irritability, and depression. 

As Aldosterone is usually present in Secondary AI, low blood pressure is not always a major symptom of Secondary Adrenal Insufficiency although low blood pressure can happen in some cases. 


adrenal crisis symptoms

Causes Of Secondary Adrenal Insufficiency

There are two main causes of Secondary Adrenal Insufficiency. The first cause being damage to the Pituitary or having a Pituitary tumour. A Tumour in the Pituitary can cause the pituitary to stop secreting ATCH hence causing the Adrenals to stop producing Cortisol. 

A secondary cause of adrenal insufficiency can be a Pituitary Tumour is usually picked up via MRI scan and a patient may have the tumour removed followed by radiation therapy.  In this case, the ability of the pituitary to produce ACTH is generally damaged forever and the so the patient becomes life long dependent on Cortisol (steroid) replacement therapy to ensure sufficient cortisol is available in the body.

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Steroid Use Can Cause Secondary Adrenal Insufficiency

The second cause of Secondary Adrenal Insufficiency is through the use of glucocorticoid medications which are often used to treat a variety of illnesses.  Glucocorticoids are steroid hormones that function the same as Cortisol. For example medications such as Cortisone, hydrocortisone, prednisone, prednisolone, inhaled and topical steroids. 

All these medications can have an effect upon ACTH as the Pituitary only produces ACTH is a response to the body’s need for Cortisol.  If the pituitary thinks the body has enough Cortisol from steroid medication, then the adrenals will slow down and once the medications are stopped the patient may suddenly become Adrenal Insufficient.  Once again need to be placed upon steroid replacement medication permanently.

Is Secondary Adrenal Insufficiency Permanent?

Some patients, certainly not all, who develop secondary AI due to Glucocorticoid medications have the potential to recover their adrenal function.  This can take between 9 months to a year and the patient may eventually be able to produce the correct amount of ACTH and Cortisol once again. 

This, however, is not always the case and many who develop Secondary AI, will become steroid dependent for life.  It’s advised you discuss this with your doctor if diagnosed with Secondary Adrenal Insufficiency as recovering from the condition is always better than being cortisol dependent for life. 

Taking Medication For Secondary Adrenal Insufficiency

People with Secondary Adrenal Insufficiency are steroid dependent. This means they are reliant upon taking cortisol medication every day.

This medication is called Hydrocortisone replacement therapy. Cortisol is the “stress hormone” and without it the body would go into adrenal crisis and eventually die.


stress dose steroids for secondary adrenal insufficiency

Stress Dose Steroids For Adrenal Insufficiency

People on steroid replacement therapy will need stress dose steroids during times of illness such as infection, high temperature, and fever.  Secondary AI patients will need to be aware of their wellbeing and any illness will need to be compensated to prevent an Adrenal Crisis. You may need to stress dose for a sudden Allergic reaction.

There may be many different reasons to take stress dose hydrocortisone in addition to your usual daily steroid amounts. You can read about this by clicking the link above. 


stress dose steroids for secondary adrenal insufficiency

Adrenal Insufficiency And Exercise

When someone with Adrenal Insufficiency exercises in a way that is more physically demanding than usual, they may need to take a little extra steroid medication beforehand to help the body cope with the added stress.

Sudden Shock With Adrenal Insufficiency

Often sudden shocks such as being in a car crash, learning of the death of a loved one or a big argument can result in a need to increase Steroid coverage.  Additional emotional stress can clear cortisol faster than usual and make an Adrenally Insufficiency patient very unwell.

Dental Treatment With Adrenal Insufficiency

Secondary Adrenal Insufficient Patients will always need extra steroid coverage during dental procedures, operations and certain hospital tests which place more than usual stress on the body.  For example during the preparation phase and during a colonoscopy

You can read about my experience at the dentist here. 

What Are The Symptoms Of Low Cortisol?

Often when low in cortisol, patients with Secondary Adrenal Insufficiency can develop brain fog and poor concentration levels. This can affect the ability to work out what medication is needed.  Therefore it is important to always wear a medic alert band and have someone with you who can help to work out how much extra hydrocortisone to take. 

When low in cortisol, there are many symptoms.  This could be feeling dizzy and being low in blood pressure, having stabbing pains, feeling weak, having an inability to stand, feeling nausea and having diarrhea. For a full list of symptoms visit the following article.

secondary adrenal insufficiency

What Is The Hydrocortisone Emergency Injection?

Secondary Adrenal Insufficiency patients will need to carry an emergency injection with them in case of sudden adrenal crisis.  The hydrocortisone emergency injection can be life-saving.  Many patients have died from an adrenal crisis and the condition should be taken seriously and can be life-threatening. Carrying an emergency injection will enable you to get treatment quickly in the case of sudden adrenal crisis. 

Vomiting With Secondary Adrenal Insufficiency

If someone with Secondary Adrenal Crisis has prolonged vomiting due to an illness or a stomach bug, they will need an emergency injection and immediate hospital treatment.

How Much Is Too Much Steroid Coverage

Too much steroid coverage on a regular basis can result in Cushing’s Symptoms, hypercortisolim, weight gain, bone problems, diabetes, and a moon-shaped face.  It is important for a patient to be on the correct dose so as to ensure they are not under or over replaced as both not enough and too much cortisol can have serious consequences.

secondary adrenal insufficiency

Raising Awareness For Secondary Adrenal Insufficiency

Secondary Adrenal Insufficiency is not an illness that is commonly talked about or researched in the same way as more well-known illnesses such as diabetes and Asthma. There is much yet to be done to help people suffering from this condition to have a better quality of life.

More research needs to be carried out to help patients affected by the condition, in particular, monitoring cortisol levels and providing cortisol medication to match the Cortisol circadian Rhythm.

I hope these 15 facts are useful and helpful. Please do share this post to help spread the word and awareness for Secondary Adrenal Insufficiency.

You may find the following content useful. 

15 Facts About Addison’s Disease

What’s it really Like to Have Adrenal Insufficiency

Children have Adrenal Insufficiency Too

Why the Adrenal Pump is a brilliant treatment for Adrenal Insufficiency 

From Cancer to Adrenal Insufficiency – A Brave Story

 My First Magazine Appearance and the fight to Kick Adrenal Insufficiency in the Butt! 

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A Doctor Diagnosed with Adrenal Insufficiency