03/05/2026
Adrenal Insufficiency: What It Is and When You Should Get Tested
What is Adrenal Insufficiency?
Adrenal insufficiency occurs when the adrenal glands do not produce enough cortisol, an essential hormone that helps regulate:
• Blood pressure
• Blood sugar
• Stress response
• Inflammation
• Energy levels
• Immune function
Your adrenal glands sit on top of the kidneys and are controlled by signals from the brain through the hypothalamic–pituitary–adrenal (HPA) axis.
There are two main types:
Primary adrenal insufficiency (Addison’s disease)
• The adrenal glands themselves are damaged.
• Often caused by autoimmune disease, infections, or genetic conditions.
Secondary adrenal insufficiency
• The adrenal glands are healthy, but the pituitary gland is not sending enough ACTH to stimulate cortisol production.
• This can occur after long-term steroid use, pituitary disorders, brain injury, or tumors.
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Common Symptoms
Adrenal insufficiency can be difficult to recognize because symptoms are often vague and develop slowly.
Symptoms may include:
• Severe fatigue or exhaustion
• Unexplained weight loss
• Dizziness or low blood pressure
• Salt cravings
• Nausea, vomiting, or abdominal pain
• Muscle or joint pain
• Low blood sugar
• Brain fog or difficulty concentrating
• Darkening of the skin (more common in Addison’s disease)
More severe cases can lead to an adrenal crisis, which is a medical emergency causing:
• Severe weakness
• Confusion
• Very low blood pressure
• Dehydration
• Shock
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When Should You Get Tested?
You should consider evaluation for adrenal insufficiency if you have:
Persistent unexplained symptoms such as:
• Chronic fatigue that does not improve with rest
• Low blood pressure or dizziness when standing
• Frequent nausea or abdominal discomfort
• Unexplained weight loss
• Recurrent low blood sugar
You may also need testing if you have risk factors such as:
• Long-term steroid medication use (prednisone, dexamethasone, etc.)
• Pituitary disorders or brain injury
• Autoimmune disease (thyroid disease, type 1 diabetes, vitiligo)
• History of adrenal gland disease
• Certain infections (TB, fungal infections)
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How Doctors Test for It
Testing typically begins with morning blood work, because cortisol naturally peaks early in the day.
Common tests include:
• 8 AM cortisol level
• ACTH level
• ACTH stimulation test (cosyntropin test) – the gold standard
• Electrolytes (sodium, potassium)
• Renin and aldosterone
• DHEA-S
If needed, imaging such as MRI of the pituitary or CT of the adrenal glands may also be performed.
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Important Note
Low cortisol on a single lab test does not automatically mean adrenal insufficiency. Diagnosis requires proper timing, repeat labs, and stimulation testing to confirm.
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💡 Bottom line:
If you have persistent fatigue, dizziness, low blood pressure, or symptoms that don’t make sense, it may be worth discussing adrenal testing with your healthcare provider.
