ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Adrenal depletion/support

Updated on November 8, 2012
Kulsum Mehmood profile image

Kulsum Mehmood is an Eye Consultant with 30 plus years of experience. She is single mother and a philanthropist. She is in a full time job.

Adrenal Insufficiency

Adrenal insufficiency results from inadequate secretion of cortisol and/or aldosterone. It is potentially fatal.One should be suspicious in cases of unexplained fatigue and hypotension.

Causes :

Most common cause is ACTH deficiency, usually because of inappropriate withdrawl of glucocorticoid therapy or a pituitary tumor. Congenital adrenal hyperplasia and Addison’s disease are rare. Common causes are :

Autoimmune, tuberculosis, HIV/AIDS, metastatic carcinomas, bilateral adrenalectomy, congenital adrenal hyperplasias, drugs ( aminoglutethimide, metyrapone, ketoconazole, etomidate etc.)

When oral steroids are prescribed for an ailment, they should not be stopped abruptly. They should be gradually tapered otherwise an adrenal crisis may result.

Clinical features :

Weight loss, malaise, weakness, anorexia, nausea, vomiting, diarrhea or constipation, postural hypotension, shock, hypoglycaemia, hypotension, shock, hyponatremia, hyperkalemia, vitiligo.

Patient may present with chronic features and/or in acute circulatory shock. In a chronic presentation, initial symptoms are often misdiagnosed as chronic fatigue syndrome or depression. Vitiligo occurs in 10-20% of patients.

Features of an acute adrenal crisis include circulatory shock with severe hypotension, hyponatrimia, hyperkalemia. Muscle cramps, nausea, vomiting, diarrhoea and unexplained fever may be present. The crisis is often precipitated by intercurrent disease, surgery or infection.

Management :

Patients with adrenocortical insufficiency always need glucocorticoid replacement therapy and usually, but not always mineralocorticoid. Other treatments depend on the underlying cause.

Glucocorticoid replacement : Cortisol ( hydrocortisone ) is the drug of choice. If patient is not critically ill, cortisol should be given by mouth, 15 mgs on waking and 5 mgs at 6 PM. The dose needs to be adjusted for a particular patient. Excess weight gain uaually indicates over-replacement, whilst persistent lethargy may be due to an inadequate dose.

An adrenal crisis is a medical emergency and requires intravenous hydrocortisone succinate 100 mgs and intravenous fluids. Injection hydrocortisone should be continued

( 100 mgs IM 6-hourly ) until gastrointestinal symptoms abate before starting oral therapy. The precipitating cause should be sought and, if possible, treated.


    0 of 8192 characters used
    Post Comment

    • Kulsum Mehmood profile imageAUTHOR

      Dr Kulsum Mehmood 

      9 years ago from Nagpur, India

      Thank you Marlene.

    • Marlene F. profile image

      Marlene F. 

      9 years ago from Richmond, Virginia

      Amazing information, You obviously did a lot of research!


    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at:

    Show Details
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the or domains, for performance and efficiency reasons. (Privacy Policy)
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)