crisis is a life-threatening condition that occurs when there is not enough cortisol, Adrenal insufficiency is an endocrine-or hormonal-disorder that occurs when the adrenal glands do not produce enough of certain hormones. The gradual destruction of the adrenal cortex, the outer layer of the adrenal glands, by the body's immune system causes up to 80 percent of Addison's disease cases. 2 n autoimmune disorders, the immune system ma!es antibodies that attac! the body"s own tissues or organs and slowly destroy them. Adrenal insufficiency occurs when at least #0 percent of the adrenal cortex has been destroyed. As a result, often both cortisol and aldosterone are lac!ing. $rimary adrenal insufficiency, also called Addison's disease, occurs when the adrenal glands are damaged and cannot produce enough of the hormone cortisol and often the hormone aldosterone. %econdary adrenal insufficiency occurs when the pituitary gland-a bean-si&ed organ in the brain-fails to produce enough adrenocorticotropin 'A(T)*, a hormone that stimulates the adrenal glands to produce cortisol. f A(T) output is too low, cortisol production drops. +,entually, the adrenal glands can shrin! due to lac! of A(T) stimulation. %econdary adrenal insufficiency is much more common than Addison's disease. Cortisol (ortisol belongs to a class of hormones called glucocorticoids, which affect almost e,ery organ and tissue in the body. (ortisol's most important -ob is to help the body respond to stress. Among its many ,ital tas!s, cortisol helps maintain blood pressure and cardio,ascular function slow the immune system's inflammatory response maintain le,els of glucose-a form of sugar used for energy-in the blood regulate the metabolism of proteins, carbohydrates, and fats The amount of cortisol produced by the adrenals is precisely balanced. (ortisol is regulated by the brain's hypothalamus and the pituitary gland. .irst, the hypothalamus releases a /trigger/ hormone called corticotropin-releasing hormone '(0)* that signals the pituitary gland. The pituitary responds by sending out A(T), which in turn stimulates the adrenal glands. The adrenal glands respond by producing cortisol. (ompleting the cycle, cortisol then signals bac! to both the pituitary and hypothalamus to decrease these trigger hormones. Aldosterone Aldosterone belongs to a class of hormones called mineralocorticoids, also produced by the adrenal glands. Aldosterone helps maintain blood pressure and water and salt balance in the body by helping the !idneys retain sodium and excrete potassium. 1hen aldosterone production falls too low, the !idneys are not able to regulate water and salt balance, leading to a drop in both blood ,olume and blood pressure. Symptoms of Addison's Disease or adrenal insufficiency The symptoms of adrenal insufficiency usually begin gradually. The most common symptoms are chronic, worsening fatigue muscle wea!ness loss of appetite weight loss Other symptoms nausea ,omiting diarrhea low blood pressure that falls further when standing, causing di&&iness or fainting irritability and depression a cra,ing for salty foods due to salt loss hypoglycemia, or low blood glucose headache sweating in women, irregular or absent menstrual periods Treatment of adrenal insufficiency in,ol,es replacing, or substituting, the hormones that the adrenal glands are not ma!ing. (ortisol is replaced with a synthetic glucocorticoid such as hydrocortisone, prednisone, or dexamethasone, ta!en orally once to three times each day, depending on which medication is chosen. f aldosterone is also deficient, it is replaced with oral doses of a mineralocorticoid, called fludrocortisone acetate '.lorinef*, ta!en once or twice a day. 2octors usually ad,ise patients recei,ing aldosterone replacement therapy to increase their salt inta!e. 2uring an Addisonian crisis, low blood pressure, low blood glucose, and high le,els of potassium can be life threatening. %tandard therapy in,ol,es intra,enous in-ections of glucocorticoids and large ,olumes of intra,enous saline solution with dextrose, a type of sugar. This treatment usually brings rapid impro,ement. 1hen the patient can ta!e fluids and medications by mouth, the amount of glucocorticoids is decreased until a maintenance dose is reached. f aldosterone is deficient, maintenance therapy also includes oral doses of fludrocortisone acetate. http344endocrine.nidd!.nih.go,4pubs4addison4addison.aspx