What’s Adrenal Insufficiency?

When we’re stressed out, our adrenal glands are there to help.

But that’s not all they do. The tiny glands—each barely larger than a stick of gum—secrete the hormone adrenaline, which we all know keeps us going when we’re stressed. But they also release cortisol, which helps regulate the metabolism and our body’s stress response; and aldosterone, which helps control blood pressure.

And if our adrenal glands stop working? That’s a potentially life-threatening situation. “If you don’t have adrenal glands, you can die,” said Dr. Carlos Isales, director of the Adrenal Gland Center at Augusta University Health. “However, if you remove one, as long as the other functions normally, you’re fine. But if you lose both, the problem is that they make some key hormones that must be replaced.”

It’s called adrenal insufficiency, and while it’s rare, certain people are at higher risk for it, if they:

Are severely malnourished
Have an autoimmune disease like lupus or rheumatoid arthritis, diabetes, asthma, or cancer and suddenly stop taking a glucocorticoid like prednisone
Have tuberculosis
Are on blood thinners
Have an adrenal tumor

Symptoms, Both Early and Severe

Symptoms of adrenal insufficiency aren’t always very specific and could easily be mistaken for symptoms of something else, says Isales. They include:

Feeling tired
Muscle weakness
Dizziness or fainting
Low blood pressure
Low blood sugar
Nausea or vomiting
Weight loss
Pain in the abdomen or muscles

Some more unique symptoms are:

You stop having a period
You crave salty foods
You notice a darkening of the skin
You’re urinating a lot
You’ve lost your sex drive

Then, say your adrenal gland isn’t working as it should and you suddenly have a stressful situation—you get sick, are in an accident or have surgery. Your body could be thrown into an adrenal crisis, which is an emergency situation. Patients may have:

Sudden, severe pain in the lower back, abdomen or legs
Vomiting and diarrhea
Weakness
Confusion
Loss of consciousness

Anyone with adrenal insufficiency should always carry an emergency corticosteroid injection with them, which could help save their life. They should also wear a medical alert bracelet so first responders can know about their condition.

Adrenal insufficiency can also lead to hyponatremia, when you don’t have enough sodium in your blood, causing confusion, fatigue, muscle twitches and even seizures. Another problem is too much potassium in your bloodstream, which could cause abnormal heart rhythms or paralysis.

If you have adrenal insufficiency, you’ll need daily medication to replace your adrenal hormones for the rest of your life. You’ll also need to monitor your stress levels carefully, and take additional medication if you have a fever or have surgery, for example.

“The condition is very real—and can be very dangerous,” said Isales. “It’s not that one day you can stop taking your medication. If you have no adrenal glands, you can die from that.”