The treatment

The treatment of secondary adrenal insufficiency is usually with the administration of drugs. The missing cortisol is thus replaced. The dosage of the cortisol is important here; this can change depending on physical condition or performance requirements.

In the case of a febrile infection, for example, the body’s cortisol requirement can increase – the externally supplied dose must then be adjusted accordingly. However, this is usually explained in detail to the patient by the treating physician at the start of therapy. In women, DHEA (dehydroepiandrosterone) can also be given in the case of a loss of libido, i.e. the loss of sexual desire. This is a so-called steroid hormone which serves as a starting point for testosterone or estrogen production.

The course of the disease

Secondary adrenal insufficiency can be treated with cortisol. The symptoms of renal cortex insufficiency then quickly recede in the course of therapy. Regular intake of cortisol and an adjusted dosage is necessary to avoid possible complications.

One of the possible consequences of a cortisol deficiency is the Addison crisis. This is life-threatening for those affected and can present itself with various symptoms such as diarrhoea, nausea/vomiting, hypoglycaemia, drop in blood pressure, etc. If such a crisis occurs, immediate emergency medical treatment with cortisol and fluid administration is necessary. Untreated, an Addison crisis can lead to death.

Difference to primary adrenal cortex insufficiency

In primary adrenal insufficiency, the defect or disease lies in the organ itself. Here, it is not the ACTH deficiency that is to blame for the hypofunction, but in the majority of cases a so-called autoimmune adrenalitis. These are autoimmune processes that lead to the destruction of tissue – the body or the adrenal cortex destroys itself due to misdirected processes.

As in secondary adrenal insufficiency, there is a lack of cortisol and androgen. Furthermore, another hormone, the so-called aldosterone, may also be affected. This hormone plays a decisive role in the water and salt balance of the body. The symptoms are sometimes almost the same. Primary insufficiency, however, can lead to a “darker coloring” of the skin, in contrast to secondary adrenal insufficiency.