What is adrenal insufficiency?

Adrenal hormones, such as cortisol and aldosterone, are hormones produced by the body to ensure that its organs and tissues function correctly.  The hormones control blood pressure and help the cardiovascular system work properly.   They also control the body’s inflammatory response and balance the body’s metabolic processes.

The brain regulates the hormone production and works alongside the pituitary gland to control the release of hormones.   In some cases the hormone production is unbalanced; the pituitary gland fails to secrete the right amount of hormones, which can result in adrenal insufficiency.

What causes adrenal insufficiency?

Primary adrenal insufficiency

In most cases this is as a result of an autoimmune disorder causing the body to attack the adrenal glands.  In 85% of cases Addison’s disease causes primary adrenal insufficiency.

In other cases, primary adrenal insufficiency can occur as a result of surgical removal of the adrenal glands or a disease directly affecting the adrenal glands.

Secondary adrenal insufficiency

Secondary adrenal insufficiency can occur through trauma, for example, a fracture of the skull base, surgery, radiotherapy or infection such as tuberculosis or meningitis.

Symptoms

Adrenal insufficiency can cause wide spread and vague symptoms such as:

• weight loss
• joint pain and muscle cramps
• syncope (fainting) and dizziness
• irritability
• digestive changes
• anorexia and weight loss
• fatigue

Diagnosis

Adrenal insufficiency can be difficult to diagnose because of the non-specific symptoms exhibited by the patient.  A full assessment is required, ensuring that a detailed medical history is taken.

A diagnosis is normally made with blood tests to check the levels of cortisol.  If an imbalance is identified, doctors then need to find the cause of the imbalance.

The preferred test to diagnose Addison’s disease is an ACTH stimulation test, where blood or urine tests are performed to check the cortisol levels before and following an injection of ACTH (adrenocorticotrophic hormone).  Patients with adrenal insufficiency will not respond to the ACTH injection as well as a normal patient, or may not respond at all.

Treatment

Understandably, adrenal insufficiency can make patients feel significantly unwell.  It can affect their day-to-day lives, in particular when symptoms such as postural hypotension are experienced resulting in fainting and blackouts when a patient stands.

Patients are normally treated with hydrocortisone tablets which need to be taken daily.   Some patients also need to take fludrocortisone and are told to increase their water and salt intake.

Misdiagnosis of adrenal insufficiency

Nikki Yavari

It can be very difficult for a doctor to identify the cause of the presenting symptoms, especially when the symptoms, including fatigue and joint pain, can mimic other conditions such as fibromyalgia, ME and lupus.  It can take a long time for the true cause of the condition to be identified. However, in order to avoid unnecessary delay it is essential that the medical professionals investigate the possibility of an adrenal imbalance.

Adrenal insufficiency can be missed for some time, resulting in an increased  period of ill health for the patient.   In the most severe cases, a failure to diagnose adrenal insufficiency can result in adrenal crisis or acute adrenal insufficiency, where a patient experiences a severe pain in the lower back, abdomen or legs, nausea and vomiting, dehydration and hypotension, which can result in a loss of consciousness.   Sadly, it can be fatal.

If you believe that you have suffered any delay in diagnosis of adrenal insufficiency which has resulted in a prolonged period of ill health or an adrenal crisis please do not hesitate to contact a member of our experienced team to discuss the possibility of making a claim for compensation.

By Nikki Yavari, medical negligence solicitor.

You can find out more about making a medical negligence claim on our web pages.