This condition — the plain-language one-pager.

What are Adrenal Disorders?Diagnosis

Your adrenal glands sit on top of each kidney and make critical hormones: cortisol (the stress hormone, regulating blood pressure, glucose, immune response), aldosterone (sodium/potassium balance), and adrenaline. Adrenal insufficiency (Addison's, primary; or secondary from prolonged steroid use) means too little cortisol — fatigue, weight loss, low BP, salt craving, and the life-threatening adrenal crisis if untreated. Cushing's syndrome means too much cortisol — central weight gain, moon face, easy bruising, hypertension, diabetes, osteoporosis, mood changes. Both are well-treated with the right specialist plan, but both are commonly missed.

• Adrenal Insufficiency / Addison's — Causes: autoimmune (most common in developed countries), tuberculosis, infection, hemorrhage, congenital. Secondary AI: pituitary disease or, far more commonly, prolonged exogenous glucocorticoid use suppressing the HPA axis. Diagnosis: 8 AM cortisol + ACTH, ACTH stimulation test. Treatment: hydrocortisone or prednisone replacement; fludrocortisone if primary AI; emergency injection (Solu-Cortef Act-O-Vial) for crises.
• Adrenal Crisis — Vomiting, severe abdominal pain, hypotension, hyperkalemia, hyponatremia, hypoglycemia. Triggered by illness, surgery, trauma, missed doses. Life-threatening — give IV/IM hydrocortisone immediately, before labs come back.
• Cushing's syndrome — Most common cause is exogenous steroid therapy. Endogenous causes: pituitary adenoma (Cushing's disease — 70% of endogenous), adrenal adenoma/carcinoma, ectopic ACTH (often small-cell lung cancer). Diagnosis: 24-hour urinary free cortisol, late-night salivary cortisol, dexamethasone suppression test. Treatment: surgery (transsphenoidal for pituitary, adrenalectomy for adrenal); medical therapy if not curable.
• Adrenal incidentalomas — Found on ~5% of abdominal imaging. Most are non-functional benign adenomas. Workup: hormonal panel (1-mg dex suppression, plasma metanephrines, aldosterone:renin if hypertensive) + size + imaging characteristics. Resection if functional, large (>4 cm), or suspicious imaging.

Sick Day Rules + Emergency Cortisol — non-negotiable for AIKnow your plan

If you have adrenal insufficiency, the difference between life and adrenal crisis is whether you double or triple your steroid dose during illness — and whether you have an emergency injection ready when you cannot keep meds down. This is not optional knowledge.

• 2x or 3x dose during illness — Fever, infection, vomiting, surgery, trauma. Call your team.
• Emergency injection — Solu-Cortef Act-O-Vial (100 mg IM) at home. Family + housemates trained. Use immediately for vomiting, dehydration, or symptoms of crisis. Then call 911.
• Medical alert bracelet/necklace — adrenal insufficiency, current dose. Wallet card with crisis instructions.
• Surgical/dental coverage — extra-stress steroid dose before procedures; tell every clinician.
• Travel kit — extra meds, injection kit, recent labs, written care plan.

Your daily Force FieldLive It

• Take replacement steroid every day, on schedule — typically split-dose hydrocortisone (mimics physiologic rhythm) or once-daily prednisone.
• Sick day doubling/tripling rule — written plan; rehearse with family.
• Carry emergency Solu-Cortef Act-O-Vial; know how to use it; family trained.
• Medical alert ID — bracelet/necklace + wallet card.
• Tell every clinician + dentist + surgeon about your AI — stress-dose coverage is mandatory.
• Salt + hydration — adequate sodium intake; fludrocortisone if primary AI.
• Annual labs — electrolytes, A1C, lipids, bone density (long-term steroid effects).
• For Cushing's — adherence to the surgical or medical plan; manage diabetes/HTN/osteoporosis aggressively; cardiac risk reduction.
• For incidentalomas — initial hormonal workup + 1- and 2-year imaging follow-up; resection criteria reviewed annually.
• Mental health — both AI and Cushing's affect mood; screen and treat.

Red flags — call nowAction

• Call your clinic the same day for: new chest discomfort with exertion that goes away with rest (stable angina worth evaluating); a missed dose of antiplatelet or statin; medication side effects (muscle aches, bleeding, GI symptoms).
• Bring up at next visit: any change in exercise tolerance, lipid follow-up timing, BP log review, smoking-cessation support, depression screening, sleep concerns.