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Insufficientia corticis glandulae suprarenalis
The adrenal makes too little cortisol — very liveable with replacement, but dangerous without emergency knowledge during infection or surgery.
Also known as: Primary adrenal insufficiency · Addisonian crisis · cortisol deficiency · hyperpigmentation
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
A rare but very treatable disease in which the adrenal cortex makes too little cortisol and usually too little aldosterone as well. In the great majority of cases an autoimmune process lies behind it, with the immune system attacking the adrenal cortex. The tricky part is the insidious onset: tiredness, lack of strength, unintended weight loss, poor appetite, nausea, abdominal pain, low blood pressure with dizziness on standing — all complaints that at first fit many other things and are therefore often read differently for a long time. Two signs are especially telling: an increasing browning of the skin that also appears at sun-protected sites such as hand creases, scars and the lining of the mouth, and a pronounced craving for salt. In the laboratory a low sodium and a raised potassium typically stand out, together with a low morning cortisol and a clearly raised ACTH. A stimulation test confirms the diagnosis. The most important reason this disease belongs in awareness is the Addisonian crisis: with infections, vomiting, accidents, operations or other severe stress the body cannot meet the increased need, and a life-threatening circulatory collapse follows. This is avoidable — through timely recognition and clear rules for sick days. Treatment is lifelong, replacing the missing hormones spread over the day along the natural rhythm. Those who know what to do can live largely normally. Indispensable are an emergency card, an emergency injection at home and knowing how to adjust the dose with fever, vomiting or surgery — following medical instructions.
Far more often than the adrenal gland itself, the control from above is affected — after a course of cortisone that has ended. The skin then stays pale and the potassium normal.
In an emergency nobody can guess the diagnosis. A card in the wallet or on the keyring ensures the right thing happens immediately — it is the single most effective protection.
With fever, infection, vomiting or severe stress the body needs more — the dose is then temporarily raised as medically instructed. Discussing these rules in advance prevents the crisis.
If vomiting makes taking tablets impossible, every minute counts. Relatives should know where the injection is and how it is used.
Surgery, dental treatment, colonoscopy and anaesthesia raise the requirement. Informing early allows proper preparation.
Tiredness alone is unspecific — combined with unintended weight loss, salt craving, darker skin or dizziness on standing, targeted assessment is worthwhile.
Thyroid, coeliac disease, type 1 diabetes and vitamin B12 deficiency often cluster — a look at these belongs to care.
Hydrocortisone replaces the cortisol the adrenal no longer makes — spread over the day, because the body needs most in the morning. It is replacement, not therapy: it cannot be left out. With fever, vomiting or surgery the dose is doubled or tripled; that point matters more than anything else.
About four to eleven per hundred thousand people are affected. The signs appear only once more than ninety per cent of the adrenal cortex has failed — which is why the diagnosis often comes late and not rarely only in a crisis. Cortisol is measured in the morning between six and eight; under 100 nmol/l counts as proof, above 500 rules it out. In a crisis, 100 milligrams of hydrocortisone are given at once, before any result is back.
Darkening creases of the palms, scars, knuckles, gums and inner cheek — like a tan without a summer. That is the one sign that separates adrenal failure from every other exhaustion.
Salty sticks, olives, salt on the food and more of it — a striking, unaccustomed craving. It has to do with the loss of salt through the kidney.
Going black before the eyes on standing up, a blood pressure that keeps falling, with nausea, belly pain and vomiting without explanation.
Flu, a stomach and bowel illness or a procedure can tip the picture within hours: severe weakness, vomiting, belly pain, very low blood pressure, confusion. That is an emergency that needs cortisone at once.
A low sodium together with a raised potassium is the classic combination and an important clue.
Rises because aldosterone is missing — especially meaningful together with a low sodium.
Measured in the morning and low — with a simultaneously high ACTH this points to the adrenal itself as the cause.
Autoimmune diseases often occur together — thyroid involvement is common and should be checked as well.
Makes sure the muscle lets go again after tensing. A lack favours cramps, twitching and inner restlessness — and the blood value reflects the store poorly.
Sets the excitability of muscle and nerve. A low value causes weakness and cramps, a high one is dangerous for the heart rhythm — here one measures rather than guesses.
Sets off the tensing in the muscle in the first place. A low value causes tingling around the mouth and in the fingers and cramping of the hands.
With heavy sweating both are lost together. Drinking only water dilutes the sodium further — with long exertion salt belongs with it.
Here salt is not a matter of taste: without aldosterone sodium is lost through the kidney, and craving salt is a hallmark of the condition. With heat and exercise the need rises further.
The counterpart: potassium tends to rise in this condition. Potassium supplements and potassium salt as a salt substitute do not belong here.
The standing cortisol dose strips substance from bone. Vitamin D and calcium therefore belong alongside, and bone density is measured at intervals.
Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.
The hormone that is missing here. It holds up blood pressure, blood sugar and the answer to stress — which is why an infection without adjusting the dose is life-threatening.
The signal from the pituitary gland. If it is high with a low cortisol, the cause lies in the adrenal gland itself; if it is low, an floor higher up. The same signal darkens the skin.
The second missing axis. It explains the craving for salt, low blood pressure, low sodium and high potassium — and it has to be replaced separately.
Without aldosterone sodium is lost. Unlike elsewhere salt is not limited but raised as needed — especially in heat, sport and diarrhoea. The amount is set with the treating team.
Cortisol holds blood sugar between meals. Without it, long gaps let it fall — 3 main meals and a snack is the usual pattern.
Possible and wanted, but the steroid dose is adjusted beforehand. An unnoticed shortfall under exertion can lead to a crisis — hence discussion before training.
checked 2026-09