As part of our commitment to provide clear, reliable information for the acromegaly community in Aotearoa, we’re pleased to share key insights from a recent international discussion on adrenal insufficiency — a condition that can affect some people following surgery or radiotherapy for pituitary adenomas.
Professor Henri Timmers is a leading endocrinologist at Radboud University Medical Center in Nijmegen, the Netherlands, where he also chairs the Radboud Center of Expertise for Adrenal Disorders.
You can watch the full interview with Prof. Timmers on the WAPO YouTube channel using the link below.
What Is Adrenal Insufficiency?
The adrenal glands sit above the kidneys and produce hormones essential for stress response, blood pressure, and blood sugar. When these glands — or the systems that control them — fail to function properly, hormone levels drop and the body struggles to respond to stress.
Prof. Henri Timmers outlined three types of adrenal insufficiency:
Primary Adrenal Insufficiency (PAI)
Damage to the adrenal glands leads to reduced hormone production. Autoimmune causes are known as Addison’s disease.
Secondary Adrenal Insufficiency (SAI)
The pituitary gland does not produce enough ACTH, so the adrenals receive insufficient signals to make cortisol. This is common in people with pituitary tumours or those who’ve had pituitary surgery.
Tertiary Adrenal Insufficiency (TAI)
The hypothalamus fails to release enough CRH, often after long-term steroid therapy, disrupting the entire HPA axis.
Symptoms and Diagnosis
Symptoms are often broad and slow to develop. Common signs include:
- Fatigue
- Muscle aches
- Headaches
- Nausea
- Unintended weight loss
Diagnosis usually begins with early morning cortisol testing. If needed, ACTH stimulation or other dynamic tests help confirm the condition.
Treatment
Treatment focuses on replacing cortisol, usually with hydrocortisone taken in two or more daily doses. The body normally increases cortisol during illness or stress, so people with adrenal insufficiency must follow sick day rules, adjusting doses to avoid adrenal crisis.
If vomiting or diarrhoea prevents tablets from being absorbed, an emergency hydrocortisone injection is essential. Some people also need fludrocortisone (for aldosterone) or DHEA.
Common Misconceptions
A frequent misconception is “adrenal fatigue.” This non-medical term suggests stress exhausts the adrenal glands, but in reality people given this label usually have high, not low, cortisol. Steroid use without medical supervision can be harmful.
Living With Adrenal Insufficiency
Many people live full lives with good management, but some symptoms — especially fatigue — may continue because medication cannot perfectly mimic the body’s natural cortisol rhythm. Awareness, preparation, and good self-management are essential.
Advice for Patients and Whānau
Prof. Timmers highlighted a few key points:
- Maintain regular follow-ups with endocrine specialists.
- Learn and follow the sick day rules.
- Know how to use an emergency hydrocortisone injection.
- Carry an emergency card or wear a medical alert bracelet.
- Stay connected with support networks.
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