Secondary adrenal insufficiency is one type of a condition where your adrenal glands don’t produce enough of the hormone cortisol. Without treatment, it can be life threatening.

Most people with adrenal insufficiency can live a typical life, but without treatment, the condition can cause a medical emergency called adrenal crisis.

Adrenal insufficiency is broken into three types depending on the underlying cause:

  • primary adrenal insufficiency, when the problem is with your adrenal glands
  • secondary adrenal insufficiency, when the problem is with your pituitary gland
  • tertiary adrenal insufficiency, when the problem is with your hypothalamus

Secondary adrenal insufficiency can develop due to a wide range of pituitary gland problems, like a tumor or head trauma.

Read on to learn more about secondary adrenal insufficiency and how it’s different than other forms of the condition.

Vs. primary adrenal insufficiency

Primary adrenal insufficiency is also known as Addison’s disease. It occurs when your adrenal glands don’t produce enough cortisol.

In about 80% to 90% of cases, primary adrenal insufficiency is caused by autoimmune disease. Other causes include:

  • adrenal gland cancer
  • surgical removal of your adrenal glands
  • adrenal gland bleeding
  • genetic conditions
  • certain medications, such as some antifungals

Vs. tertiary adrenal insufficiency

Tertiary adrenal insufficiency is due to problems with your hypothalamus that cause the underproduction of corticotrophin-releasing hormone (CRH). CRH acts on your pituitary gland to produce adrenocorticotropic hormone (ACTH). ACTH then stimulates the production of cortisol from your adrenal glands.

Tertiary adrenal insufficiency is usually due to suddenly stopping corticosteroids after taking them for an extended period.

Secondary adrenal insufficiency causes similar symptoms as Addison’s disease, such as:

Fatigue is the most common symptom of secondary adrenal insufficiency, followed by low sex drive and headaches.

People with secondary adrenal insufficiency are more likely to experience low blood sugar than people with primary adrenal insufficiency, but they’re less likely to have:

People with secondary adrenal insufficiency can also have panhypopituitarism, where they have low levels of other hormones secreted by the pituitary gland.

Learn more about the hormones secreted by your pituitary gland.

Secondary adrenal insufficiency is due to the underproduction of ACTH by your pituitary gland. The underproduction of this hormone leads to reduced cortisol secretion by your adrenal glands.

Many problems with your pituitary gland can lead to secondary adrenal insufficiency, such as:

People who have tumors in their pituitary gland have a high risk of developing adrenal insufficiency. Most pituitary tumors aren’t cancerous.

Pituitary tumors usually don’t cause problems unless they grow large. Autopsy and imaging studies suggest that they may occur in 14.4% to 22.5% of people. Only about 0.5% of pituitary tumors come to medical attention

Secondary adrenal insufficiency can lead to a life threatening complication called adrenal crisis. Adrenal crisis is when your body can’t produce enough cortisol to counteract stress. It seems to be less common in people with secondary adrenal insufficiency compared with primary adrenal insufficiency.

Primary and secondary adrenal insufficiency are both associated with increased mortality rates due to:

  • cardiovascular disease
  • metabolic disease
  • infectious disease

It’s important to get medical attention if you believe you may have symptoms of adrenal insufficiency, such as unexplained fatigue or unintentional weight loss. A doctor can help you figure out if your symptoms are due to adrenal insufficiency or another cause.

Medical emergency

It’s important to get immediate medical attention if you or somebody you’re with has symptoms of adrenal crisis, such as:

A doctor can start the diagnostic process by:

  • considering your symptoms
  • reviewing your personal and family medical history
  • performing a physical exam

If they suspect adrenal insufficiency, they’ll likely order an ACTH stimulation test. This test involves giving you an injection of a synthetic version of ACTH to see if it increases your cortisol levels.

Other tests you may receive include:

  • insulin tolerance test to see if insulin causes your body to produce more ACTH
  • CRH stimulation test to diagnose secondary or tertiary adrenal insufficiency
  • antibody blood tests
  • CT scan
  • pituitary MRI scan
  • pituitary biopsy

Doctors primarily treat secondary adrenal insufficiency with glucocorticoid medications to replace your cortisol levels. The prescribed medication is often hydrocortisone or prednisone.

If the underlying cause of your adrenal insufficiency is permanent, you’ll have to take these medications for the rest of your life.

Is secondary adrenal insufficiency reversible?

Secondary adrenal insufficiency may not be reversible if it’s due to permanent damage to your pituitary gland. Some causes may be reversible, such as tumors that can be surgically removed.

If you have adrenal insufficiency, you can live a typical life if you receive proper treatment and go to regular follow-ups. You’ll have to take medications for the rest of your life if the cause of your hormonal imbalance isn’t curable.

People who don’t receive treatment are at risk of developing adrenal crisis.

Secondary adrenal insufficiency is often unpreventable. Experts haven’t linked pituitary tumors to any preventable factors.

Some causes, like head trauma, may be somewhat preventable. You can prevent head trauma by:

  • wearing a seatbelt in vehicles
  • wearing a helmet when biking or performing activities with a risk of head injury
  • wearing protective gear during sports
  • avoiding activities with a high risk of head injury

Secondary adrenal insufficiency develops when you have a problem with your pituitary gland that causes it to underproduce the hormone ACTH. Low levels of ACTH lead to the underproduction of cortisol from your adrenal glands.

Secondary adrenal insufficiency is often treatable with oral glucocorticoids. Without treatment, you’re at risk of developing a life threatening condition called adrenal crisis.