Adrenal insufficiency is a rare but serious condition where the body cannot produce enough of certain essential hormones, leaving people unable to respond properly to stress, illness, or injury. Understanding this condition can help protect your health and well-being.

What Is Adrenal Insufficiency?

Adrenal insufficiency happens when the adrenal glands, two small organs sitting just above your kidneys, fail to make enough hormones that your body needs to survive. These tiny glands play a huge role in keeping you alive by producing hormones that help you respond to stress, control blood pressure, manage blood sugar levels, and maintain the balance of salt and water in your body.^[1]

The condition comes in three different forms, depending on where the problem originates. Primary adrenal insufficiency, often called Addison’s disease, occurs when the adrenal glands themselves are damaged and cannot produce hormones. Secondary adrenal insufficiency happens when the pituitary gland, a pea-sized structure at the base of your brain, doesn’t make enough of a hormone called ACTH (adrenocorticotropic hormone), which tells the adrenal glands what to do. Tertiary adrenal insufficiency starts even higher up, in the hypothalamus, which normally tells the pituitary to release ACTH.^[1]

When someone has primary adrenal insufficiency, they typically lose production of both cortisol and aldosterone, two critical hormones. However, people with secondary or tertiary forms usually still make aldosterone normally, which means they may have fewer problems with blood pressure and salt balance than those with Addison’s disease.^[2]

How Common Is Adrenal Insufficiency?

Adrenal insufficiency is considered rare. In the United States, Addison’s disease affects approximately 1 in 100,000 people, making it an uncommon diagnosis that doctors may not immediately consider when patients first present with symptoms.^[7] In developed countries like the United States and Western Europe, the estimated prevalence is about one person in every 20,000.^[13]

Secondary adrenal insufficiency is more common than the primary form, with a prevalence of around 1 in 3,000 individuals. This higher frequency is largely due to one major cause: the use of steroid medications for treating other conditions.^[20]

The condition can affect people of all ages, but Addison’s disease most commonly appears in adults between 30 and 50 years old. However, children can also develop adrenal insufficiency, and when they do, it requires careful management to ensure proper growth and development.^[7][5]

What Causes This Condition?

The causes of adrenal insufficiency vary depending on which type a person has. Understanding what triggers the condition can help people recognize their risk and seek early diagnosis.

For primary adrenal insufficiency, the most common cause in developed nations is an autoimmune attack. This means the body’s immune system mistakenly identifies the adrenal glands as foreign invaders and destroys them. More than 90 percent of recent-onset cases show the presence of antibodies against an enzyme called 21-hydroxylase, which the body needs to make cortisol. These antibodies can appear years or even decades before symptoms develop.^[13][2]

Other causes of primary adrenal insufficiency include infections that damage the adrenal glands, bleeding within the glands, genetic disorders that are inherited from parents, surgical removal of the adrenal glands, and metastatic cancer that spreads to the adrenals. In some cases, tuberculosis or other infections can destroy adrenal tissue.^[2][3]

Secondary adrenal insufficiency has different triggers. The most common cause is taking steroid medications like prednisone, hydrocortisone, or dexamethasone for extended periods to treat conditions such as asthma, arthritis, or inflammatory diseases. When people take these medications, the pituitary gland senses the presence of cortisol-like substances and reduces its own production of ACTH. Over time, this can cause the adrenal glands to shrink and stop working properly.^[10][1]

Other causes of secondary adrenal insufficiency include pituitary tumors, surgery or radiation treatment affecting the pituitary gland, head injuries, and certain inflammatory diseases. Increasingly, doctors are also recognizing that high-dose opiate pain medications can suppress the body’s natural cortisol production.^[20][2]

Who Is at Greater Risk?

Certain groups of people face higher chances of developing adrenal insufficiency. Recognizing these risk factors can help with earlier detection and treatment.

People with other autoimmune diseases are at increased risk of developing Addison’s disease. If you have type 1 diabetes, thyroid problems like Graves’ disease or chronic thyroiditis, pernicious anemia, vitiligo (a skin condition causing loss of pigment), myasthenia gravis, or dermatitis herpetiformis, your immune system has already shown a tendency to attack your own body. This makes you more likely to develop autoimmune adrenal insufficiency as well.^[7]

Those with autoimmune polyendocrine syndrome, a rare inherited condition where the immune system attacks multiple hormone-producing glands, have a much higher likelihood of developing Addison’s disease. This syndrome often affects the adrenal glands along with the parathyroid glands and mucous membranes.^[7]

Anyone taking glucocorticoid medications regularly faces risk for secondary adrenal insufficiency. This includes not only oral pills but also inhaled steroids for asthma, topical steroid creams used over large areas of skin for extended periods, and steroid injections. The longer you take these medications and the higher the dose, the greater your risk of developing suppressed adrenal function.^[10]

People with pituitary problems, whether from tumors, surgery, radiation therapy, or injury to the head, may develop secondary adrenal insufficiency because their pituitary can no longer properly signal the adrenal glands.^[2]

Recognizing the Symptoms

The symptoms of adrenal insufficiency often develop slowly over months, making them easy to overlook or attribute to other causes like stress, aging, or general fatigue. Because the onset is gradual, many people ignore early warning signs until the condition becomes more severe.^[3]

Extreme tiredness that doesn’t improve with rest is the most common symptom. This isn’t just feeling tired at the end of a busy day—it’s a profound fatigue that makes even simple daily activities feel exhausting. People often describe feeling completely drained of energy for weeks or months on end.^[7]

Dizziness or feeling faint when standing up happens because adrenal insufficiency causes low blood pressure. When you move from sitting or lying down to standing, your blood pressure may drop suddenly, making you feel lightheaded. This is called postural hypotension.^[3]

Digestive problems are common and can include nausea, vomiting, diarrhea, loss of appetite, and pain in the stomach area. These symptoms may come and go, and some people lose weight without trying because they simply don’t feel like eating.^[3][7]

Muscle weakness, widespread body aches, muscle cramps, and joint pain can make physical activity difficult and uncomfortable. Your legs may feel especially heavy, and you might notice pain in your lower back.^[4][7]

Changes in skin appearance occur primarily in people with Addison’s disease. Areas of darkened skin, called hyperpigmentation, may appear especially on scars, skin creases, joints like knuckles and elbows, and on the gums inside the mouth. This darkening happens because when cortisol levels are low, the body produces more ACTH, which also stimulates pigment production. These changes may be harder to notice on people with darker skin tones.^[3][7]

Many people develop intense cravings for salty foods because their bodies are losing salt due to low aldosterone levels. You might find yourself reaching for potato chips, pretzels, or adding extra salt to everything you eat.^[7]

Changes in mood and mental function can include irritability, depression, poor concentration, and difficulty focusing on tasks. Some people experience trouble sleeping, which worsens the fatigue they already feel.^[7]

Women may notice changes in their menstrual cycles, with irregular or missed periods. Loss of body hair and decreased interest in sex can also occur due to low levels of adrenal hormones called androgens.^[3][7]

In children, symptoms may include slow weight gain, failure to grow at a normal rate, and general weakness. Children might also appear unusually tanned or have darkened skin creases and gums, just like adults with Addison’s disease.^[5]

Can Adrenal Insufficiency Be Prevented?

Because the most common cause of primary adrenal insufficiency is autoimmune disease, there is currently no way to prevent it from developing. The immune system’s attack on the adrenal glands happens for reasons that scientists don’t fully understand, and no lifestyle changes or interventions can stop this process once it begins.^[2]

However, secondary adrenal insufficiency related to steroid medication use can often be prevented or minimized. If you need to take glucocorticoid medications for conditions like asthma, arthritis, or inflammatory diseases, your doctor should prescribe the lowest effective dose for the shortest time possible. When it’s time to stop the medication, your doctor will create a plan to gradually taper the dose down rather than stopping abruptly, giving your adrenal glands time to recover their function.^[10]

For people already diagnosed with adrenal insufficiency, preventing complications is crucial. This means taking your replacement hormones exactly as prescribed, never missing doses, and learning to recognize situations that require extra medication. Carrying emergency identification like a medical alert bracelet and having an emergency injection kit available can prevent life-threatening crises.^[4][8]

People with one autoimmune disease should remain aware that they face higher risk of developing additional autoimmune conditions, including Addison’s disease. Regular check-ups with your doctor and reporting new symptoms promptly can help catch adrenal insufficiency early if it develops.^[13]

How the Body Changes in Adrenal Insufficiency

Understanding what goes wrong inside the body helps explain why adrenal insufficiency causes so many different symptoms affecting multiple body systems.

Cortisol, sometimes called the “stress hormone,” has jobs throughout the entire body. It helps maintain blood pressure by affecting how blood vessels constrict and relax. It controls blood sugar levels by affecting how the liver produces and releases glucose. It reduces inflammation throughout the body and helps the immune system function properly. Cortisol also plays a role in metabolism, influencing how your body uses fats, proteins, and carbohydrates for energy.^[1]

When cortisol levels drop too low, blood pressure falls because blood vessels don’t maintain their normal tone. This is why people feel dizzy when standing and why severe adrenal insufficiency can lead to shock. Blood sugar levels may drop dangerously low, especially during fasting or illness, causing weakness, confusion, and sweating. The body loses its ability to respond appropriately to stress, which is why even minor illnesses can become serious medical emergencies for people with adrenal insufficiency.^[7]

Aldosterone manages the balance of sodium (salt) and potassium in your blood by controlling how much of each the kidneys retain or excrete in urine. When aldosterone is too low, the kidneys lose too much sodium and retain too much potassium. Losing sodium means losing water along with it, which reduces blood volume and drops blood pressure even further. This is why people with Addison’s disease often crave salt—their bodies are trying to replace what’s being lost.^[1]

The darkening of skin in Addison’s disease occurs through a biochemical mechanism. When the adrenal glands fail, the pituitary gland produces more and more ACTH trying to stimulate them. ACTH is made from a larger molecule that also produces melanocyte-stimulating hormone, which triggers pigment production in the skin. This is why the increased ACTH levels cause hyperpigmentation, particularly in areas already containing more pigment like skin creases, scars, and areas exposed to friction.^[7]

In secondary and tertiary adrenal insufficiency, the problem originates higher up in the control system. The pituitary or hypothalamus fails to produce enough ACTH or the hormone that triggers ACTH release. Without this signal, the adrenal glands don’t receive instructions to make cortisol. Over time, without stimulation, the adrenal glands actually shrink and their capacity to produce hormones diminishes further. However, because aldosterone production doesn’t depend on ACTH, these forms of adrenal insufficiency spare that hormone, which is why blood pressure problems and salt imbalances are typically less severe.^[1][4]

During times of physical stress like illness, injury, or surgery, healthy people naturally produce two to ten times more cortisol than usual to help the body cope. People with adrenal insufficiency cannot do this, which is why situations that healthy people easily handle—like a stomach virus or dental work—can rapidly become life-threatening for someone with this condition. Without the protective surge of cortisol, the body cannot maintain blood pressure, blood sugar, or other vital functions under stress.^[8][14]