My Life With Adrenal Insufficiency


Secondary Adrenal Insufficiency

Secondary Adrenal Insufficiency is a serious and life threatening illness where the Pituitary gland in the brain fails to send sufficient amounts of the hormone ACTH to the Adrenal glands resulting in insufficient amounts of Cortisol being released into the blood stream. 

Here are 15 facts about Secondary Adrenal Insufficiency to help you better understand the condition.



Secondary Adrenal Insufficiency

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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.


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


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 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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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 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 and once again need to be placed upon steroid replacement medication permanently.


Some patients, certainly not all, who develop secondary AI due to Glucocorticoid medications have the potential to recover the 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. 


People with Secondary Adrenal Insufficiency are steroid dependent. This means they are reliant upon taking cortisol medication every day. Cortisol is the “stress hormone” and without it the body would go into adrenal crisis and eventually die.


People on steroid replacement therapy will need to stress dose 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


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.

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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.


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.


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.


Secondary Adrenal Insufficiency patients will need to carry an emergency injection with them in case of sudden adrenal crisis. The emergency injection can be life saving. Many patients have died from adrenal crisis and the condition should be taken serious and can be life threatening.


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.


Too much steroid coverage on a regular basis can result in Cushing’s Symptoms, 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 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.

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  1. I see this say that sai is only cuased by 2 things which is false. My daughter was born with a ectopic pituitary glad, which also causes SAI. Please update this article so people can be properly educated. Thank you

    1. This article states that their are two main causes for SAI, This is true and correct. The only way to get SAI is via pituitary damage (damaged caused for different reasons) or from taking excess steroids.

      Pituitary damage can be caused by a tumour (which is the most common reason for pit damage) or damage can occur during an accident such as a car crash or blow to the head or in your child’s case being born with damage due to an ectopic Pituitary.

      So I will not be altering this article as it is correct and your clearly taking a personal stance because It did not mention the specific cause of your child’s illness.

      Just because I say, “the two main way” does not rule out every single other option. This article is about SAI and the most common cause of the illness. It is not an article about every possible cause and clearly you have taken this personally.

      1. Thanks for posting this article. I haves shared it with everyone because it’s simple and to the point. I have SAI due to taking asthma medication. There is very little information out there about SAI and the symptoms don’t necessarily match AI. I developed severe fatigue for six months before other symptoms occurred. I have never had low blood pressure. So your article is correct that SAI patients don’t always have low blood pressure. I was the first documented patient at a major hospital to develop SAI from an inhaled steroid. Four years later I am still steroid dependent and suffer from chronic fatigue. A couple of your articles mention dosing for above normal exercise? Do you know where I can find information on this topic?

    1. ???? It’s 15 facts not every single fact. However it can for sure be caused by that! The name is Sheehan’s disease and causes secondary AI. I have that!

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