Exploring the Effects of Low Cortisol Levels on Your Health and Well-being

Low cortisol can cause fatigue, low blood pressure, and weight loss, and in severe cases a life-threatening adrenal crisis. See a doctor.

Cause

Adrenal insufficiency (Addison’s disease) or pituitary problems. Steroid withdrawal also.

Symptoms

Fatigue, weight loss, low blood pressure, dizziness, salt craving, nausea and dark skin patches.

Crisis

Adrenal crisis: severe weakness, vomiting and shock. It is life threatening.

Treatment

Hydrocortisone replacement.

Tests

Morning cortisol and ACTH stimulation test.

Emergency

Call 911.

Adrenal insufficiency

Low cortisol results from primary adrenal insufficiency (Addison disease, when the adrenal glands are damaged), secondary adrenal insufficiency (low ACTH from the pituitary) or sudden stopping of long-term steroid medicine. Addison disease affects about 1 in 10,000 to 15,000 people, and in developed countries autoimmune disease is the leading cause.

• Symptoms include fatigue, weight loss, low blood pressure, salt craving, dizziness, nausea, abdominal pain and darkening of skin (in primary disease).
• Tests include an early-morning cortisol, ACTH stimulation test and ACTH level.
• Treatment is hydrocortisone and, in primary disease, fludrocortisone.

Crisis

An adrenal crisis is life-threatening, with severe weakness, vomiting, low blood pressure, confusion and low blood sugar. It requires an immediate injection of hydrocortisone and emergency care. People with adrenal insufficiency should wear medical alert ID and carry an emergency injection kit, with stress doses during illness or surgery. Do not stop steroid medicines suddenly without a doctor.

Adrenal insufficiency

Low cortisol is called adrenal insufficiency. Primary (Addison disease) results from adrenal gland damage, most often autoimmune, and secondary from pituitary problems or stopping long term steroid medicine. Symptoms include fatigue, weight loss, low blood pressure, salt craving, nausea and darkened skin in Addison disease. Prevalence of Addison disease is roughly 100 to 140 cases per million people.

Crisis

An adrenal crisis causes vomiting, severe weakness, confusion and shock, and needs emergency hydrocortisone injection. People with the condition take daily replacement and carry emergency injection kits. Never stop steroids suddenly without medical supervision.

Adrenal insufficiency

Low cortisol is called adrenal insufficiency. Primary insufficiency (Addison disease) results from adrenal gland damage, most often autoimmune in developed countries, and secondary insufficiency results from pituitary problems or stopping long term steroids suddenly. It affects roughly 100 to 140 people per million for Addison disease.

Symptoms and emergency

Symptoms include fatigue, weight loss, low appetite, nausea, low blood pressure, salt craving, low blood sugar and darkened skin in Addison disease. An adrenal crisis causes severe vomiting, confusion, low blood pressure and collapse, and is a medical emergency needing injected hydrocortisone. Diagnosis uses a morning cortisol and ACTH stimulation test. Treatment is lifelong hydrocortisone or similar steroid, with extra doses during illness, and a medical alert bracelet is advised. Do not stop steroid medicines without a doctor.

Based on data from the Endocrine Society and the National Institute of Diabetes and Digestive and Kidney Diseases