Navigating Adrenal Insufficiency: Cortisol

January 14, 2024by Dr. S. F. Czar0

Case Study:

Patient Profile:

Name: Sarah

Age: 45

Gender: Female

Chief Complaint:

Sarah presented to the endocrinologist’s office with a history of chronic fatigue, unexplained weight loss, recurrent infections, and episodes of dizziness. She had been experiencing these symptoms for several months and was seeking an explanation for her declining health.

Case Presentation:

History and Initial Assessment:

Sarah reported a gradual onset of symptoms, including debilitating fatigue that had forced her to take frequent naps during the day. She had lost approximately 15 pounds over the past six months without changes in her diet or physical activity. Additionally, she mentioned that she had been feeling lightheaded and dizzy when changing positions.

Physical Examination:

During the physical examination, the healthcare provider noted hyperpigmentation of Sarah’s skin, particularly on her face, elbows, and knees. Her blood pressure was found to be significantly low, with orthostatic hypotension observed when she stood up from a sitting position. These clinical findings raised suspicions of adrenal insufficiency.

Laboratory Investigations:

Blood tests were ordered to assess Sarah’s hormonal profile. The results revealed low morning cortisol levels, elevated adrenocorticotropic hormone (ACTH) levels, hyponatremia, and hyperkalemia. These findings strongly indicated adrenal insufficiency, particularly primary adrenal insufficiency or Addison’s disease.

Diagnosis and Treatment:

Adrenal Crisis:

  • Given the severity of Sarah’s symptoms and the electrolyte imbalances, she was admitted to the hospital with a diagnosis of an adrenal crisis, a life-threatening complication of adrenal insufficiency. Intravenous fluids and high-dose intravenous hydrocortisone were administered promptly.
Confirmation of Diagnosis:
  • Further diagnostic tests, including an ACTH stimulation test, confirmed the diagnosis of primary adrenal insufficiency (Addison’s disease). The ACTH stimulation test showed an inadequate cortisol response to exogenous ACTH.
Cortisol Replacement Therapy:
  • Sarah was started on oral hydrocortisone, a synthetic glucocorticoid, to replace the deficient cortisol. The healthcare provider prescribed a daily regimen to mimic the body’s natural cortisol secretion pattern.
Stress Management:
  • Sarah received education on the importance of stress management and the need to adjust her medication during times of illness, stress, or surgery to prevent an adrenal crisis.
Regular Follow-Up:
  • Sarah was scheduled for regular follow-up appointments to monitor her hormonal levels and ensure proper cortisol replacement. Her healthcare provider emphasized the importance of compliance with medication and promptly seeking medical attention during any illness or stressor.
Outcome and Progress:

For several months, Sarah’s symptoms improved significantly. Her energy levels increased, and she regained the lost weight. Orthostatic hypotension resolved, and her electrolyte imbalances normalized. Regular monitoring ensured appropriate cortisol replacement, and Sarah learned to manage her condition effectively.


Sarah’s case illustrates the diagnostic and management challenges of adrenal insufficiency, particularly primary adrenal insufficiency or Addison’s disease. Prompt recognition of symptoms, diagnosis, and initiation of cortisol replacement therapy is crucial in preventing life-threatening adrenal crises. Patients with adrenal insufficiency must receive education on stress management and medication adjustments, allowing them to lead healthy lives despite their hormonal disorders. This case underscores the importance of healthcare providers’ vigilance in identifying and managing hormonal disorders like adrenal insufficiency to improve patients’ overall well-being.

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