Adrenal Insufficiency
Adrenal insufficiency occurs when the adrenal glands do not produce enough cortisol, the hormone central to stress response, blood pressure, glucose regulation, and inflammation. Primary insufficiency (Addison's disease) is an adrenal gland problem; secondary insufficiency results from inadequate ACTH from the pituitary, most commonly caused by chronic corticosteroid use.
When to Book
Book a visit if symptoms are new, persistent, getting worse, or affecting daily life. Early evaluation often prevents complications.
Symptoms
Profound fatigue, muscle weakness, unintentional weight loss, decreased appetite, nausea, abdominal discomfort, postural dizziness, salt craving, low blood pressure, and — in primary Addison's disease — hyperpigmentation of skin creases, scars, and mucous membranes.
Causes & Risk Factors
Autoimmune adrenalitis causes 80% of primary cases. Other causes include tuberculosis, HIV, fungal infections, metastatic cancer, bilateral adrenal hemorrhage, and adrenoleukodystrophy. Secondary insufficiency most commonly results from long-term exogenous steroid suppression of the HPA axis.
How We Evaluate
An 8 AM cortisol below 3 mcg/dL is highly suggestive. The ACTH stimulation test (250 mcg cosyntropin, cortisol at 30 and 60 minutes) is the gold-standard confirmatory test. ACTH level distinguishes primary from secondary. Adrenal antibodies confirm autoimmune Addison's. CT imaging evaluates adrenal structure.
Treatment Options
Hydrocortisone (or prednisolone) replaces cortisol on a two- to three-times-daily dosing schedule mimicking the diurnal rhythm. Fludrocortisone replaces aldosterone in primary insufficiency. Sick-day rules — doubling the dose for fever or illness — and medic-alert identification are essential safety measures.
When It Is Urgent
Adrenal crisis is a life-threatening emergency: severe weakness, vomiting, abdominal pain, hypotension, confusion, or unresponsiveness during illness or after a missed dose. Administer hydrocortisone 100 mg IV or IM immediately and go to the ER.
Frequently Asked Questions
Do I need a referral to see an endocrinology provider?
No referral is needed at Nomi Beach Health. You can book directly with our team for hormone, thyroid, metabolic, or weight-management concerns.
How long does it take to see results from treatment?
Timeline depends on the condition. Thyroid medication often improves symptoms within four to eight weeks. Weight-loss interventions show measurable changes in four to twelve weeks. Hormone therapy timelines vary by the specific condition and individual response.
Will I need labs before my first visit?
You can come in without prior labs — we order whatever is appropriate during or after your visit. If you have recent results, bring them so we can start the conversation right away.
Are these conditions managed long-term or treated once?
Most endocrine and metabolic conditions require ongoing management rather than a single treatment. We build a follow-up schedule around your specific diagnosis and goals.
Can I be seen for weight loss even if I do not have a hormone diagnosis?
Yes. We evaluate weight holistically — including metabolic markers, lifestyle factors, and, when appropriate, medication options such as GLP-1 agonists.
Get a Clear Plan for Adrenal Insufficiency
Our endocrinology team evaluates you as an individual and builds a treatment plan that fits your life — not a template.