Adrenal Insufficiency: Types, Causes, Symptoms, Diagnosis, and Treatment

You’ve felt worn out for months. You get dizzy when you stand up, the scale keeps dropping, and someone at home says it’s just weakness. Lately, you’ve started craving salt with every meal. When blood tests come back “mostly normal,” it’s easy to stop asking questions.

Sometimes the answer is adrenal insufficiency. It means your adrenal glands aren’t making enough cortisol, a hormone your body can’t function without. There are three main types. All of them can be treated, but a sudden drop called an adrenal crisis is a medical emergency.

This guide comes from the endocrinology team at PSRI Hospital, Sheikh Sarai. We’ve treated patients since 1996 and hold NABH and NABL accreditation. In The Times of India’s February 2026 hospital survey, PSRI Hospital ranked No. 2 in Delhi.

What Is Adrenal Insufficiency, and Why Does It Leave You So Drained?

Adrenal insufficiency is a condition where your adrenal glands make too little cortisol, and sometimes too little aldosterone. These two small glands sit on top of your kidneys. Cortisol keeps your blood pressure and blood sugar steady. Aldosterone tells your kidneys how much salt and water to keep.

Low cortisol leaves your muscles and brain short of the sugar and blood flow they run on. That’s why the tiredness doesn’t lift with sleep.

What Are the Three Adrenal Insufficiency Types?

The three adrenal insufficiency types are primary, secondary and tertiary. Doctors name each one after the point where the hormone chain breaks. Your brain sends a signal, a gland below it passes the message on, and the adrenal glands respond.

The pituitary gland is a pea-sized gland at the base of the brain. It releases ACTH, a messenger hormone that tells the adrenal glands to make cortisol. The hypothalamus is the brain area just above it that starts the chain.

Primary (Addison’s Disease): The Adrenal Glands Are Damaged

In primary adrenal insufficiency, also called Addison’s disease, the problem sits in the adrenal glands themselves. They can’t make enough cortisol or aldosterone, even though the brain keeps asking for more. Because aldosterone drops too, salt and water balance often goes off.

Secondary: The Pituitary Gland Sends Too Few Signals

Here, the adrenal glands are healthy, but the pituitary doesn’t release enough ACTH. With a weak signal, the glands slow down. Aldosterone usually stays close to normal in this type, since a separate system controls it.

Tertiary: The Brain’s Starting Signal Drops

Tertiary adrenal insufficiency starts in the hypothalamus. The usual trigger is long-term steroid medicine that’s stopped or cut back too fast. Months of high doses teach the brain it doesn’t need to send signals, and restarting takes time.

What Are the Most Common Adrenal Insufficiency Causes in India?

Steroid medicine is the most common of all adrenal insufficiency causes. According to a JAMA patient guide published in 2026, steroid-induced adrenal insufficiency is the leading cause overall. When the damage sits in the adrenal glands themselves, infections matter far more in north India than in the West.

Long-Term or Unprescribed Steroids

Steroids treat asthma, arthritis and skin disease. Tablets and injections taken for months can switch off your own cortisol production, and so can strong creams or inhalers used heavily.

Some steroid exposure is hidden. Doctors have reported cases where unlabelled tonics, powders or pain injections contained steroids the patient never knew about. If you’ve taken any medicine without a clear label, tell your doctor.

Infections: Histoplasmosis and Tuberculosis

Some infections can destroy both adrenal glands. Histoplasmosis is a fungal infection that can spread through the body and reach the adrenals. A 2023 study from Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, tracked north Indian patients with the primary type. The causes it found:

45% had histoplasmosis
25% had autoimmune damage
15% had adrenal tuberculosis
6% had lymphoma, a type of blood cancer

In Western countries, autoimmune damage is the leading cause of the primary type. Adrenal TB can appear 10 to 15 years after the first infection. You can read more about tuberculosis and how it spreads.

Autoimmune Damage

In autoimmune disease, the immune system attacks the body’s own tissue by mistake. When it targets the adrenal glands, hormone levels fall slowly over years. People with this type sometimes have thyroid disease or type 1 diabetes as well.

Pituitary Problems

Anything that harms the pituitary can lead to the secondary type, including:

A pituitary tumour, or surgery and radiation near it
A serious head injury
Heavy bleeding during or after childbirth, known as Sheehan’s syndrome
Some long-term pain medicines, such as opioids

Which Adrenal Insufficiency Symptoms Do People Usually Miss?

The adrenal insufficiency symptoms people miss most are the slow, vague ones. Tiredness, poor appetite and mild nausea build over months. So they get blamed on work, age or a new baby. Watch for these:

Fatigue that lasts for weeks, even with rest
Weight loss you can’t explain
Dizziness or blackouts when you stand
Nausea, vomiting or belly pain
Muscle and joint aches
Low mood or irritability
Irregular periods in women

If weight loss is your main worry, our guide to causes of sudden weight loss covers the other reasons doctors check.

Signs That Point to the Primary Type

Two clues point strongly to primary adrenal insufficiency. One is darker skin, especially on knuckles, palm creases, gums and old scars. Very high ACTH levels cause it. The other is a strong salt craving, which comes from low aldosterone.

Is This the Same as “Adrenal Fatigue”?

No. Adrenal fatigue is a label used online for stress-related tiredness. The Endocrine Society says it isn’t a real medical condition. Adrenal insufficiency is different: blood tests confirm it, and it needs hormone replacement. If you’ve been sold supplements for “adrenal fatigue,” ask for a cortisol test instead.

When Does Adrenal Insufficiency Become an Emergency?

Adrenal insufficiency becomes an emergency during an adrenal crisis. That’s a sudden, severe drop in cortisol that can push blood pressure down to shock levels. In the Lucknow study, 42% of patients first reached a doctor this way.

An infection, vomiting, an injury or surgery can set off a crisis. The warning signs:

Severe weakness, or being unable to stand
Confusion or extreme drowsiness
Repeated vomiting or diarrhoea
Sudden, severe pain in the belly, lower back or legs
Fainting, or cold and clammy skin
High fever

If you spot these signs at home, act fast:

Call for emergency help or go to the nearest emergency department right away.
If the person has an emergency steroid injection and you’ve been shown how to give it, use it.
Take their steroid card and medicine list to the hospital.
Tell the doctors the patient may have adrenal insufficiency.
Don’t wait at home for symptoms to settle.

For families in South Delhi, 24×7 emergency care at PSRI Hospital is a short drive from Panchsheel Park and Khirki Extension.

How Do Doctors Diagnose Adrenal Insufficiency?

Doctors diagnose adrenal insufficiency with a few blood tests, usually taken in the morning when cortisol is naturally highest. Then they look for the cause:

A Detailed History. Your doctor asks when your symptoms began and notes every steroid course you’ve had.
Morning Blood Tests. Your doctor checks cortisol and ACTH together. Low cortisol with high ACTH points to the primary type.
An ACTH Stimulation Test. A nurse injects a lab-made form of ACTH, then checks cortisol 30 to 60 minutes later. Healthy adrenal glands respond with a clear rise.
Sodium and Potassium Checks. Low sodium and high potassium suggest aldosterone is low too.
Scans. A CT scan of the adrenal glands or an MRI of the pituitary helps find the cause.
Infection Tests. If the adrenals look enlarged, doctors may test for TB or fungal infection.

Steroids in any form and birth control pills can change cortisol results. Don’t stop or skip either before testing unless your doctor says so.

What Does Adrenal Insufficiency Treatment Involve?

Adrenal insufficiency treatment replaces the hormones your body can’t make and treats the cause where possible. For most people, that means daily tablets.

Replacing the Missing Hormones

The main medicine replaces cortisol. People with the primary type usually need a second medicine to replace aldosterone. Your endocrinologist sets the dose and adjusts it based on your symptoms and test results.

Treating the Cause

If an infection damaged the glands, it needs its own treatment. Histoplasmosis needs antifungal medicine, and adrenal TB needs a full TB course. A pituitary tumour may need surgery, radiation or medicine, depending on its type.

Coming Off Long-Term Steroids Safely

Steroid-induced adrenal insufficiency needs a slow, planned taper. Your doctor lowers the dose in small steps over weeks or months, giving the glands time to restart. Morning cortisol tests show when it’s safe to stop completely.

Sick Day Rules and the Steroid Alert Card

Your body needs more cortisol when you’re ill. Sick day rules are your doctor’s written instructions on adjusting your dose during fever, vomiting or surgery. Ask for them before you leave the clinic. Carry a steroid alert card or bracelet too, so emergency staff know what to do if you can’t speak.

Will You Need Steroids for Life, and Are Replacement Doses Harmful?

Replacement doses copy the amount of cortisol your body should make on its own. They’re much lower than the high doses used for asthma attacks or arthritis flares, which cause most well-known steroid side effects.

Many families in India worry the moment they hear the word “steroid.” They’ve often seen weight gain, high sugar or weak bones in someone on high doses. How long you need replacement depends on your type:

Primary: usually lifelong, because damaged adrenal glands don’t recover
Secondary: depends on whether the pituitary recovers
Steroid-induced: often temporary, as JAMA notes this type is usually reversible

Missed doses carry a real risk, because they can trigger a crisis. Your doctor tracks your weight, blood sugar and bone health at follow-up visits. Never stop or change your dose without talking to your endocrinologist.

When Should You See an Endocrinologist?

See an endocrinologist when the symptoms above continue for weeks and routine tests haven’t explained them. An endocrinologist is a doctor who treats hormone problems. Book sooner in two situations:

Your doctor plans to stop steroids you’ve taken for months
Your blood reports have shown low sodium or high potassium more than once

Bring these to your first visit:

Your last three months of blood reports
The dates and doses of every steroid course you remember
Records of any past TB treatment or pituitary surgery

Book Your Consultation at PSRI Hospital Now!

Most people with long-term tiredness don’t have adrenal insufficiency, and that’s exactly why it gets missed in those who do. A morning cortisol test gives a clear answer either way. If this guide describes you or someone at home, ask your doctor for that test this week. If you’ve taken steroids for months, keep taking them as prescribed until an endocrinologist has checked your adrenal function.

At PSRI Hospital, our endocrinologists confirm the diagnosis, find the cause and set your replacement dose. For people with suspected adrenal insufficiency, we provide:

Hormone testing in our NABL-accredited laboratory
CT and MRI scans and infection tests in the same hospital
Joint planning with our lung, joint and skin specialists if you take steroids for another condition
Written sick day rules and a steroid alert card before you go home

Many people search for the best hospital in Delhi when a diagnosis feels this serious. If you’re comparing lists of top 10 hospital in Delhi, ask one plain question. Can this hospital test you, treat the cause and handle a crisis without sending you elsewhere?

We’re at Press Enclave Marg, Sheikh Sarai II, near Saket Court. Patients reach us easily from Saket, Hauz Khas and Greater Kailash, or via Chirag Delhi and Malviya Nagar Metro stations.

Looking for the best hospital in New Delhi for hormone testing near Saket? Call +91 84 84 84 84 17 to book with our endocrinology team at PSRI Hospital.

Medical Disclaimer: This content is for general awareness only and does not replace medical advice. Please consult a qualified doctor for diagnosis and treatment based on your symptoms, medical history and test results. For emergency symptoms, call +91 84 84 84 84 17 or visit the nearest emergency department.

Frequently Asked Questions

Can Adrenal Insufficiency Cause Weight Gain?

Untreated adrenal insufficiency usually causes weight loss. Weight gain after diagnosis can happen when the replacement dose is higher than your body needs. That’s one reason your endocrinologist reviews your dose at regular visits. Report any steady gain to your doctor instead of cutting your tablets yourself.

Is Adrenal Insufficiency Hereditary?

Most cases aren’t passed down directly. Congenital adrenal hyperplasia is a rare genetic condition that runs in families and usually shows up in childhood. Autoimmune adrenal insufficiency can also cluster in families. If a parent, brother or sister has it, tell your doctor even if your own symptoms are mild.

Can Women With Adrenal Insufficiency Have a Healthy Pregnancy?

Many women do, with careful planning. Hormone needs change during pregnancy, especially in the last three months and during delivery. Your endocrinologist and obstetrician will plan dose changes together. Talk to them before you try to conceive, and make sure the delivery team knows about your condition.

Why Does the Order of Thyroid and Cortisol Treatment Matter?

Some people have low thyroid and low cortisol at the same time. Thyroid medicine speeds up how fast the body uses cortisol. Starting it before cortisol is replaced can trigger an adrenal crisis. That’s why endocrinologists test both hormones and correct cortisol first when both are low.

Can You Keep Religious Fasts With Adrenal Insufficiency?

Speak to your endocrinologist before any fast, including Navratri, Karva Chauth or Ramadan. Long hours without food or water raise the risk of low blood sugar and dehydration. Your doctor may change the timing of your tablets around fasting hours. Never skip a dose to keep a fast.