Secondary Adrenal Insufficiency: Care Instructions

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Your Care Instructions

Your adrenal glands sit on top of your kidneys. They make hormones that affect almost every organ in your body.

Secondary adrenal insufficiency means that your adrenal glands don't make enough of a hormone called cortisol. Cortisol helps maintain blood pressure. It helps break down sugar and fat for energy. It also helps manage stress.

The problem starts with the pituitary gland. It's located at the base of your brain. Normally it sends a signal to the adrenal glands to make more cortisol. The signal is a hormone that the pituitary gland makes, called ACTH. When the pituitary gland doesn't make enough ACTH, the adrenal glands won't make enough cortisol.

This can happen if the pituitary gland is damaged by things like a tumour or surgery.

Treatment involves replacing the hormones that your body needs. You might get some of these hormones in the hospital. Some people will take hormones at home for the rest of their lives. Hormones may be pills or injections (shots).

If possible, your doctor will treat the condition that damaged the pituitary gland.

Some people may need urgent care because they have what is called an adrenal crisis. It can be caused by severe infection or stress. Symptoms may include:

  • Severe vomiting and diarrhea.
  • Extreme weakness.
  • A high fever.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

  • Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor or nurse call line if you think you are having a problem with your medicine.
  • Do not reduce salt in your diet. You may need to add extra salt to your food during hot and humid weather or after exercise. The extra salt can replace the salt your body loses through sweating.
  • Do not use salt substitutes.
  • Wear medical alert jewellery. This lets others know that you have adrenal insufficiency.
  • Keep track of your weight, especially if you have not been hungry or you have been vomiting. Weigh yourself at the same time of day while wearing the same amount of clothing.
  • Ask your doctor when he or she wants to be told about weight loss or frequent vomiting.
  • Keep track of your blood pressure. Your medicine may need to be adjusted if:
    • You have high blood pressure that causes swelling.
    • You have low blood pressure that leaves you light-headed.
  • Have clear instructions written out for which medicine you should take more of and how much more you should take. During illness or stress, you may need a higher dose of medicine. Talk with your doctor about when and how much you should increase your dose.
  • Have a shot of emergency medicine ready at your home, at work or school, and in the car. Know when and how to give yourself the shot. Have instructions written out. Teach someone else how to give you the shot in case you can't give it to yourself.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You have symptoms of an adrenal crisis. These may include:
    • Severe vomiting and diarrhea.
    • Feeling extremely weak or like you're going to faint.
    • Sudden pain in your belly, lower back, and legs.
    • Strange behaviour, such as feeling confused or fearful.
    • A high fever.
    • A pale face, and blue lips and earlobes.

Call your doctor or nurse call line now or seek immediate medical care if:

  • You have trouble taking medicines by mouth.
  • You have a fever.

Watch closely for changes in your health, and be sure to contact your doctor or nurse call line if:

  • You do not get better as expected.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

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