Primary adrenal insufficiency occurs when adrenal glands are diseased or damaged. If the pituitary gland somehow is damaged or altered, it can affect adrenal gland cortisol secretion, even if the adrenal glands are healthy. Secondary adrenal insufficiency is most commonly caused by medications, such as prednisone, intra-articular injections with steroids, or steroid creams. In this situation, the adrenal glands may take days to months to recover function and restore proper cortisol production.
Signs and symptoms of adrenal insufficiency often come on gradually and progressively worsen over months. Diagnosis sometimes is delayed because early symptoms can easily be mistaken for something else. The most common signs and symptoms include muscle weakness and fatigue; muscle, joint or abdominal pains; and decreased appetite and weight loss.
In addition, signs and symptoms can include lightheadedness, feeling wiped out by an ordinary illness, depression, nausea, vomiting or diarrhea.
Cravings for salt and darkening of skin, especially on the face and hands, or on moles, scars or skin folds, are seen only with primary adrenal insufficiency. Symptoms of adrenal insufficiency can develop suddenly and rapidly into an adrenal crisis.
Baseline characteristics and outcomes of the patients are shown in Table 1. Nineteen patients were lost to follow-up during the study, four patients voluntarily stopped the hormone substitution, two patients died unrelated to GCA and one patient relapsed. After 2 years at test 3 , 15 of these patients had still not recovered. By year three at test 4 , 4 patients were responders whereas 7 were not. Among patients with a negative first ACTH test, recovery of adrenal function occurred in a mean time of 14 months; the maximal time until recovery was 51 months, and this patient needed five tests.
Only, three of these patients received a metyrapone test, which confirmed this status. Basal cortisol concentrations were significantly lower in patients who did not respond to the first ACTH test. Daily GC dosage at 3, 6 and 12 months, treatment duration, and cumulative dose were significantly different all were higher in non-responders. The occurrence of GC-associated adverse events did not differ between the responders and non-responders.
We then transferred the continuous quantitative data to their qualitative counterparts. In Table 2 , univariate analyses show there was a significantly increased risk of a negative response for each parameter for non-responders, with odds-ratios OR ranging from 1.
Multivariate analyses confirmed this independent significant association. Table 2. Univariate analyses of glucocorticoid GC dose and duration in relation to adrenal insufficiency at the first ACTH stimulation. Our results also indicate that increased treatment duration is at least partially due to the increased occurrence of relapses.
No previous study has reported this in patients with GCA. Thus, our study is the largest to describe secondary adrenal insufficiency in older patients with rheumatic disease. The strength of our study lies in its large and homogeneous recruitment, the standardized treatment procedure, and the limited number of patients lost to follow-up.
None of our patients had an adrenal crisis. However, our patients were given hormone substitution and were strictly followed up. Although the risk of developing such a severe complication has been known since the s, its real frequency remains controversial [ 11 , 12 ].
One could explain the very low frequency of adrenal crisis by its central origin: the glucocorticoid-induced negative feedback to the hypothalamic and pituitary glands may result in an adrenal crisis, but usually only if there is acute physiological stress e. Thus, given the rarity of an adrenal crisis, systematic ACTH testing does not seem to be justified. However, symptoms of slow adrenal insufficiency e.
Thus, detecting slow adrenal insufficiency may be critical because of its considerable impact on quality of life and the potential risk of disability. Our study confirmed that total dose and duration of GC were predictive factors [ 8 , 11 , 13 ]. We determined the thresholds of 6 and 12 months of therapy, which may help physicians to evaluate an increased risk of adrenal insufficiency.
One limitation of our study may be the age- or inflammation-related changes to the HPA axis. However, previous studies have reported no difference in the response of the HPA axis between young and older subjects [ 14 , 15 ].
Finally, inflammatory markers i. This controversy has been lasting since the value of the low-dose test was reported by Dickstein et al. Recently, two meta-analyses have been performed to try to settle this question. The first one, by Dorin et al. Both studies included some patients with corticosteroid therapy.
Overall, none of the standard or the low-dose test is able to detect the entire HPA axis dysfunction. Nevertheless, these tests are the most convenient for daily practice as the insulin hypoglycaemia test is not recommended in the elderly because of dangerousness and metyrapone test can have major side effects [ 18 ]. After a first negative test, the mean time until recovery of adrenal function was 11 months range , similar to that of our study.
These data suggest that the accuracies of standard and low-dose ACTH tests are similar for the detection of secondary adrenal insufficiency in the population of patients with GCA. For patients at risk, a safe and reasonable way to proceed could be to taper GCs more slowly and to perform a first ACTH stimulation test before GC withdrawal. If this is abnormal, a second test should be performed after 12 and 24 months if needed. Services Services.
Book a Consultation. Back to All Blog Posts. How to Recover From Adrenal Fatigue. Below we outline steps for recovery from adrenal fatigue.
Adrenal Fatigue Defined Adrenal glands sit atop your kidneys and produce a variety of hormones, including cortisol. Symptoms of Adrenal Fatigue How do you know if you are suffering from adrenal fatigue? Common symptoms of adrenal fatigue include: Change in blood pressure Lightheadedness, like with low blood sugar Night sweats Brain fog Fatigue or low energy levels Depression Anxiety Lack of Motivation Craving salty or sweet foods Weight gain or weight loss Sleep changes or Insomnia Severe Premenstrual Syndrome Low libido What To Do If You Have Symptoms Symptoms of adrenal fatigue can replicate other health issues , and your first step toward recovery from adrenal fatigue should be to seek the help of a medical professional.
Below are some top-level things you can do right now to start decreasing the stress load on your adrenal glands: Toss out the alcohol Practice good sleep habits regular sleep and wake time; plenty of sleep Meditate daily Eliminate processed carbs and sugar Do light, refreshing exercise Eliminate toxicity both from yourself and others Find community Step into your purpose Support your body with key nutrients and supplements talk to your doctor Stop stressing!
Partnering with an Adrenal Fatigue Doctor At Five Journeys, our professionals offer a variety of services that can help mend your adrenal glands. Functional Medicine As you start on your recovery path, the Five Journeys team first seeks to understand not only your symptoms, but also your story. Learning Your Story We feel every detail is important to the overall picture of your current health.
Biological Testing We use cutting-edge technology and specialty lab testing to help determine both the source of issues and the path for treatment. Identifying the Cause With our gathered information, we then analyze the catalysts beneath your condition. Relationship with Our Team A supportive relationship with one of our specialists will ensure success for your recovery. Diet and Nutrition A good diet needs more than healthy fat and Himalayan sea salt. Detox Adrenal fatigue is the result of stress; therefore, we focus on eliminating stress-related toxins.
Supplements and Vitamins A slight imbalance in an important nutrient can lead to a condition that then leads to another imbalance that leads to another condition. Intravenous IV Therapy IV treatments can ease symptoms of adrenal fatigue and other health conditions.
IV Therapy can benefit in the following ways: Benefits Your Immune System Our IV treatments are packed with essential vitamins and nutrients which help defend against the common cold and seasonal flu. Increases Energy Levels If you suffer from adrenal fatigue, you know how low your energy levels can drop.
Alleviates symptoms of Depression and Anxiety More energy makes you more active, and exercise helps you feel less depressed. Aids Mental Function Are you tired of feeling like you are always in a daze? For more information, contact us today! Stay in the loop! What are symptoms of gut issues and how to treat them? All About IV Therapy. Our Latest Articles. Healthy and Allergy Friendly Halloween.
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