Adrenal insufficiency

Adrenal insufficiency happens when the adrenal glands don’t produce enough steroid hormones. One of those steroid hormones is cortisol which serves many important functions for your body, including regulating metabolism, controlling blood pressure, and influencing your immune system. The cortisol level is usually decreased in adrenal insufficiency. Levels of other hormones made by the adrenal glands (aldosterone and androgens) can be in the lower range, depending on the underlying cause. There are 2 types of adrenal insufficiency: primary and secondary.

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Primary adrenal insufficiency is a rare condition that occurs when the adrenal glands have been damaged and can’t produce enough hormones. Addison’s disease is the most common cause of primary adrenal insufficiency. Secondary adrenal insufficiency is when the pituitary gland doesn’t produce enough of the hormone ACTH (adrenocorticotropin).

Impact of adrenal insufficiency on fertility

Adrenal insufficiency can disrupt the menstrual cycle, and many women with this condition have irregular periods. Addison’s disease is associated with autoimmune thyroid disease and primary ovarian insufficiency (when the egg reserve is depleted before the age of 40), which are known to reduce fertility.

In women with congenital adrenal hyperplasia and non-classical congenital adrenal hyperplasia, elevated progesterone during the follicular phase can alter the cervical mucus. This makes it more difficult for sperm to swim to an egg and interferes with the thickening of the uterine lining to prepare the womb for implantation.

During pregnancy, women with adrenal insufficiency are more likely to have a miscarriage, preterm birth, or need a C-section. But close management by an endocrinologist and OB-GYN can help you have a pregnancy without complications.

Potential causes of adrenal insufficiency

Primary adrenal insufficiency is usually due to an autoimmune disorder in which the immune system mistakenly attacks the healthy adrenal glands. It may also be caused by:

• Fungal infections
• Tuberculosis infection of the adrenal glands
• Genetic disorders (i.e. congenital adrenal hyperplasia)
• Surgical removal of the adrenal glands
• Cancer

Secondary adrenal insufficiency is caused by a lack of the hormone ACTH. This can be because of:

• Tumors on the pituitary gland
• Reduced blood flow to the pituitary gland
• Removal of or radiation to the pituitary gland
• Removal of parts of the hypothalamus (part of your brain that produces hormones)

Taking certain prescription medications (prednisone, hydrocortisone, and dexamethasone) can also cause a temporary decrease of ACTH.

Symptoms of adrenal insufficiency

The main symptoms include: 

• Severe fatigue 
• Weight loss 
• Nausea 
• Dizziness 
• Abdominal pain 
• Low blood pressure 
• Low sugar levels 
• Irregular or missed periods (amenorrhea) 
• Darkened skin on the face, neck, and hands 

When the body is under stress from illness, infection, surgery, or an accident, these symptoms can become much worse all of a sudden and lead to an emergency condition called adrenal crisis. If you experience stomach issues like severe nausea and vomiting, diarrhea, or faint, please seek urgent medical care.

Diagnosis of adrenal insufficiency

Adrenal insufficiency is diagnosed with blood and urine tests that measure the levels of adrenal hormones and ACTH. The ACTH stimulation test involves measuring the blood cortisol levels before and after an injection of ACTH. You may also have imaging tests (X-rays, ultrasound, MRI, or CT scan).

Treatment to improve fertility

With medication that replaces the missing adrenal hormones, you can live a long and healthy life and improve your fertility. Glucocorticoids are a type of medication that replace cortisol, and mineralocorticoids replace aldosterone. Some women may need androgen replacement therapy as well. These medications work to put the hormone levels back into balance and offer relief from symptoms. 

You may also be recommended to make some nutritional changes like increasing your intake of vitamin D (read here why this vitamin matters for fertility).

This article has been verified by a medical professional

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