Symptoms of adrenal insufficiency

Medically reviewed by Neka Miller, PhD on January 12, 2020. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

When your body doesn’t produce enough cortisol, the hormone responsible for your stress response and other important functions, you may experience symptoms associated with adrenal insufficiency (or hypocortisolism).

To better describe how adrenal insufficiency can impact one’s well-being, let’s first dig into what adrenal insufficiency is and the adrenal insufficiency symptoms that can develop—so keep reading.


What is adrenal insufficiency?

Adrenal insufficiency, also referred to as hypocortisolism or Addison’s disease, is a condition where the adrenal glands fail to produce enough cortisol to perform important functions in your body—such as managing the stress response and playing a role in metabolism, immune function, and inflammatory processes.

Adrenal insufficiency is broken down into 3 categories, described below.

Primary adrenal insufficiency (Addison’s disease): A condition resulting from damage to the adrenal cortex, preventing the adrenal glands from properly functioning and leading to decreased cortisol production. In the United States, it’s most commonly caused by immune system malfunction, but other possible causes include infection and cancer.

Secondary adrenal insufficiency: This develops when the pituitary gland in your brain fails to produce enough adrenocorticotropic hormone (ACTH), which is responsible for stimulating the adrenal cortex to produce cortisol.

Tertiary adrenal insufficiency: A condition in which the hypothalamus—the region in your brain that links the nervous system and the endocrine system through the pituitary gland—releases an inadequate amount of corticotropin-releasing hormone (CRH), the hormone that tells the pituitary gland to produce ACTH.

Adrenal insufficiency symptoms: What are the symptoms of low cortisol levels?

Cortisol is key for many important functions, such as responding to stress, regulating your metabolism, controlling blood sugar levels, and regulating your salt and water balance. When your body doesn’t produce enough of the hormone, some of these functions may be negatively affected, which can lead to a number of health issues.

While many symptoms of low cortisol are not exclusive to adrenal insufficiency, knowing the signs can be a helpful starting point in understanding if you may have low levels of cortisol.

Below are the common signs and symptoms to consider if you suspect you may be experiencing low cortisol levels, or adrenal insufficiency.

Signs and symptoms of primary adrenal insufficiency (Addison’s disease) may include:

  • Extreme fatigue
  • Weight loss
  • Dehydration
  • Decreased appetite
  • Irritability
  • Depression
  • Darkening of the skin (known as hyperpigmentation)
  • Low blood pressure
  • Fainting
  • Craving for salt
  • Hypoglycemia (low blood sugar)
  • Nausea
  • Diarrhea
  • Vomiting
  • Pain in the abdomen
  • Muscle or joint pains
  • Loss of body hair
  • Menstrual cycle irregularities

Keep in mind that these signs and symptoms can occur for reasons other than adrenal insufficiency—so if you’re experiencing any of the above symptoms, be sure to discuss them with your healthcare provider to understand what steps to take next.

Signs and symptoms of secondary and tertiary adrenal insufficiency

The symptoms for secondary and tertiary adrenal insufficiency are similar to the ones listed for primary adrenal insufficiency above, with a few exceptions such as the following:

  • Hyperpigmentation does not occur
  • Dehydration is less common
  • Low blood pressure is less common
  • Low blood sugar is more common

Symptoms of adrenal insufficiency vary from person to person, and it’s worth noting that diagnosing adrenal insufficiency requires evaluation by a healthcare professional.

Identifying primary adrenal insufficiency (Addison’s disease)

Addison’s disease, the autoimmune disease that causes your adrenal glands to produce less cortisol than they should to perform important functions in your body, is often identified through blood tests for several different biological markers, including cortisol, ACTH (via the ACTH stimulation test), sodium, and potassium. A diagnosis may be supported through a variety of other specialized tests, including the insulin-induced hypoglycemia test and an X-ray examination.

What are cortisol levels?

What is adrenal insufficiency?

Cortisol levels and stress: how cortisol levels and stress are connected

Cortisol and sleep: Do cortisol levels affect sleep?


1. Addison's disease. Mayo Clinic. URL. Accessed January 12, 2020.

2. Physiology, Cortisol. StatPearls. URL. Accessed January 12, 2020.

3. Addison Disease. MedlinePlus. URL. Accessed January 12, 2020.

4. Definition and Facts of Adrenal Insufficiency & Addison's Disease. National Institutes of Health. URL. Accessed January 12, 2020.

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