Our Health Library information does not replace the advice of a doctor. Please be advised that this information is made available to assist our patients to learn more about their health. Our providers may not see and/or treat all topics found herein.

Secondary Adrenocortical Insufficiency

Topic Overview

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.

This may be caused by:

  • A tumor 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.

The symptoms of secondary adrenocortical insufficiency are similar to those of Addison's disease. (But darkening of the skin and high levels of potassium in the blood are not present like they are in Addison's disease.)

With secondary adrenocortical insufficiency, only cortisol is low. The adrenal glands can still make normal amounts of 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.

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

If your doctor suspects secondary adrenocortical insufficiency, you may get infusions of ACTH on 2 days in a row. In most cases, your adrenal glands will make cortisol by the end of the second treatment. This is true even if you have problems with the pituitary gland or hypothalamus. If possible, your doctor will treat the condition that is causing secondary adrenocortical insufficiency. Your doctor may start treatment during the testing if he or she thinks adrenal insufficiency is likely. If it turns out that you don't need treatment, you can stop treatment after testing is complete.

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

Related Information

References

Other Works Consulted

  • Moore J (2015). Adrenocortical insufficiency. In ET Bope, RD Kellerman, eds., Conn's Current Therapy 2015, pp. 722–725. Philadelphia: Saunders.

Credits

Current as of: July 29, 2019

Author: Healthwise Staff
Medical Review: E. Gregory Thompson, MD - Internal Medicine
Kathleen Romito, MD - Family Medicine
David C. W. Lau, MD, PhD, FRCPC - Endocrinology

COVID-19 Updates

Do you ever feel at times due to life being so busy you put your health on hold? Now is the time to take care of you! For many of our patients we have postponed your annual exam by moving it out a few months in response to COVID-19, but we still want to make sure we have the opportunity to take care of you from afar. If you are our patient and have not had the opportunity for us to review your cancer family history with you, or maybe you have just put this on hold, here is the opportunity for you to fill out your information in a few quick steps online to see if testing is right for you! This questionnaire on your medical history will be posted to our website as well to access and to complete. So take control of your health today! We will be happy to direct you to right resources and follow up with you for any questions you may have.

OBGALS Logo