Secondary Adrenocortical Insufficiency

Condition Basics

What is secondary adrenocortical insufficiency?

Secondary adrenocortical insufficiency is a condition in which a lack of adrenocorticotropic hormone (ACTH) prevents the body from producing enough cortisol.

Production of cortisol is controlled by the action of ACTH. ACTH is produced by the pituitary gland. This gland is controlled by the hypothalamus in the brain. If either the hypothalamus or pituitary gland is damaged, less ACTH is produced. This can lead to problems with the adrenal glands and reduced cortisol production.

What causes it?

Secondary adrenocortical insufficiency may be caused by:

• A tumour of the pituitary gland or hypothalamus.
• Past radiation of the hypothalamus or pituitary gland.
• Past surgery to the pituitary gland.
• Rare conditions such as hemochromatosis, sarcoidosis, or Sheehan's syndrome (hypopituitarism). Sheehan's syndrome is sometimes caused by severe blood loss after giving birth.

What are the symptoms?

With secondary adrenocortical insufficiency, only cortisol is low. The adrenal glands can usually still make normal amounts of the hormone aldosterone. Symptoms include:

• Fatigue and muscle weakness. These may get worse over time.
• Weight loss. Profound weight loss is a prominent symptom.
• Loss of appetite.
• Headaches.

How is it diagnosed?

Diagnosis starts with a medical history and physical exam. If your doctor suspects adrenal insufficiency, the doctor will check your blood cortisol and ACTH levels. You may have imaging tests of the adrenal glands, the pituitary gland, or the hypothalamus.

CT scan or MRI can be used to see if there are signs of damage to the brain or pituitary gland (such as a tumour) that is causing adrenal failure.

How is secondary adrenocortical insufficiency treated?

If possible, your doctor will treat the condition that is causing secondary adrenocortical insufficiency. Treatment will also include medicines like corticosteroids (hydrocortisone). You and your doctor will work together to find the dose that works best for you. It is also important to ask your doctor what to do when your body is under stress.