Feeling persistently tired, dizzy, or unwell can be frustrating, especially when you cannot pinpoint the cause. While many conditions can lead to chronic fatigue and weakness, low cortisol symptoms due to adrenal insufficiency is one possibility that should not be overlooked. Understanding the symptoms of low cortisol and adrenal insufficiency is essential for protecting your health and seeking timely medical care. This guide will help you recognise the warning signs, understand what causes low cortisol, and know when to consult a healthcare professional.

What Is Adrenal Insufficiency?

Adrenal insufficiency is a condition in which your adrenal glands do not produce sufficient amounts of cortisol, a vital hormone that helps your body respond to stress, regulate blood pressure, control blood sugar levels, and support your immune system. When cortisol levels drop too low, your body struggles to function normally, leading to a range of low cortisol symptoms that can significantly impact your daily life.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), there are two main types of adrenal insufficiency:

Primary Adrenal Insufficiency (Addison’s Disease)
This occurs when the adrenal glands themselves are damaged and cannot produce adequate cortisol and often aldosterone, another important hormone. Addison’s disease is rare and can be caused by autoimmune disease, infections, or other factors that damage the adrenal glands.

Secondary Adrenal Insufficiency
This develops when the pituitary gland in your brain fails to produce enough adrenocorticotropic hormone (ACTH), which signals the adrenal glands to make cortisol. This type is more common and can result from long-term use of corticosteroid medications, pituitary tumours, or other conditions affecting the pituitary gland.

Recognising Low Cortisol Symptoms

The symptoms of adrenal insufficiency often develop gradually and can be subtle at first, making them easy to dismiss or attribute to stress or a busy lifestyle. However, recognising these low cortisol symptoms early is crucial for proper diagnosis and treatment.

Persistent Fatigue and Weakness

One of the most common low cortisol symptoms is ongoing, unexplained fatigue that does not improve with rest. You may feel physically weak and find it difficult to complete everyday tasks that previously felt effortless. This extreme tiredness often worsens progressively over time.

Low Blood Pressure and Dizziness

Cortisol plays a key role in maintaining healthy blood pressure. When cortisol levels are low, you may experience dizziness, lightheadedness, or even fainting, particularly when standing up quickly. This occurs because your blood pressure drops more than it should when you change position.

Unexplained Weight Loss and Loss of Appetite

Many people with adrenal insufficiency experience a noticeable decrease in appetite, leading to unintentional weight loss. Food may seem unappealing, and you might feel full quickly or experience nausea.

Hyperpigmentation (Darkening of the Skin)

In primary adrenal insufficiency specifically, you may notice darkening of your skin, particularly in areas exposed to friction such as elbows, knees, knuckles, and scars. This occurs because low cortisol triggers increased production of ACTH, which can stimulate melanin production. This symptom does not typically occur in secondary adrenal insufficiency.

Salt Cravings

A strong, persistent craving for salty foods is a classic sign of adrenal insufficiency, particularly primary adrenal insufficiency. This occurs because the adrenal glands also produce aldosterone, which helps regulate sodium levels. When aldosterone is low, your body loses sodium and craves salt to compensate.

Mood Changes and Depression

Low cortisol can affect your mental health, leading to irritability, mood swings, anxiety, or depression. You may feel emotionally fragile or find it harder to cope with everyday stressors.

Digestive Problems

Nausea, vomiting, abdominal pain, and diarrhoea are common symptoms. These digestive issues can worsen during times of stress or illness when your body’s demand for cortisol increases.

When to See a Doctor for Low Cortisol Symptoms

If you experience several of these symptoms persistently, it is important to schedule an appointment with a healthcare professional. Early diagnosis of adrenal insufficiency is vital because the condition can worsen over time and lead to serious complications if left untreated.

You should seek medical attention if you notice:

• Chronic fatigue that does not improve with rest
• Persistent low blood pressure or frequent dizziness
• Unintentional weight loss combined with poor appetite
• Darkening of your skin without sun exposure
• Intense salt cravings that are new or unusual for you
• Ongoing digestive problems without an obvious cause

Don’t ignore persistent symptoms. If you’re concerned about hormonal health issues, consider our Express Health Screening for quick and comprehensive evaluation.

Emergency Symptoms: Adrenal Crisis

An adrenal crisis, also known as an Addisonian crisis, is a life-threatening emergency that occurs when cortisol levels drop dangerously low. This can be triggered by severe stress, illness, injury, surgery, or suddenly stopping corticosteroid medications. The Mayo Clinic advises seeking immediate emergency medical help if you experience:

• Sudden, severe abdominal, back, or leg pain
• Severe vomiting and diarrhoea leading to dehydration
• Extremely low blood pressure causing confusion or loss of consciousness
• High fever or signs of severe infection

An adrenal crisis requires immediate treatment with intravenous corticosteroids and fluids. Without prompt intervention, it can be fatal.

How Adrenal Insufficiency Is Diagnosed

Diagnosing adrenal insufficiency requires a thorough evaluation by a healthcare professional. Because low cortisol symptoms can be vague and overlap with many other conditions, specific tests are necessary to confirm low cortisol levels and determine the underlying cause.

Medical History and Physical Examination

Your doctor will begin by discussing your symptoms in detail and reviewing your medical history, including any medications you are taking, particularly corticosteroids. A physical examination will check for signs such as low blood pressure, skin changes, and weight loss.

Blood Tests to Measure Cortisol Levels

A morning cortisol blood test is often the first step. Cortisol levels are naturally highest in the early morning, so a low reading at this time can indicate adrenal insufficiency. However, a single low cortisol reading is not always conclusive.

ACTH Stimulation Test

This is the most reliable test for diagnosing adrenal insufficiency. During this test, you receive an injection of synthetic ACTH, and your blood cortisol levels are measured before and after the injection. If your cortisol levels do not rise appropriately, it confirms that your adrenal glands are not functioning properly. The Endocrine Society provides detailed information about this diagnostic process.

Imaging and Additional Diagnostic Tests

Depending on your results, your doctor may order imaging studies of the adrenal or pituitary glands to identify any structural abnormalities. Our Radiology services offer advanced imaging capabilities including ultrasound and X-ray to support accurate diagnosis of endocrine conditions.

Frequently Asked Questions

Can stress cause low cortisol levels?

Paradoxically, while acute stress increases cortisol production, chronic prolonged stress can sometimes lead to dysregulation of the stress response system. However, true adrenal insufficiency is caused by physical damage to the adrenal glands or problems with the pituitary gland, not simply by everyday stress or a demanding lifestyle.

Is adrenal insufficiency the same as adrenal fatigue?

No. Adrenal insufficiency is a recognised medical condition with measurable low cortisol levels that requires medical treatment. “Adrenal fatigue” is not a medically recognised diagnosis and is not supported by scientific evidence. If you are experiencing chronic fatigue, it is important to see a doctor for proper evaluation rather than self-diagnosing.

Can adrenal insufficiency be cured?

Primary adrenal insufficiency (Addison’s disease) cannot be cured, but it can be effectively managed with lifelong hormone replacement therapy. Secondary adrenal insufficiency may be reversible if the underlying cause, such as stopping corticosteroid medication gradually, can be addressed. With proper treatment, most people with adrenal insufficiency can lead normal, active lives.

What happens if adrenal insufficiency is left untreated?

Untreated adrenal insufficiency can lead to an adrenal crisis, which is a medical emergency. It can also cause ongoing symptoms that severely impact your quality of life. Early diagnosis and treatment are essential to prevent serious complications.

How is adrenal insufficiency treated?

Treatment involves replacing the hormones that your adrenal glands are not producing. This typically includes daily oral corticosteroid medication such as hydrocortisone. In primary adrenal insufficiency, you may also need to replace aldosterone with fludrocortisone. Your doctor will work with you to adjust your medication doses based on your individual needs.

Do I need to adjust my medication during illness or stress?

Yes. During periods of illness, injury, or significant stress, your body requires more cortisol than usual. Your doctor will provide guidance on how to increase your medication temporarily during these times to prevent an adrenal crisis. It is important to wear a medical alert bracelet and carry an emergency injection kit if prescribed.

Protecting Your Health Through Regular Screening

Persistent, unexplained symptoms should never be ignored. If you are experiencing chronic fatigue, dizziness, weight loss, or other concerning signs, taking action is the best way to safeguard your wellbeing. Early detection of adrenal insufficiency ensures you receive the appropriate treatment and avoid potentially serious complications.

For busy professionals experiencing low cortisol symptoms, our Executive Health Screening packages provide comprehensive hormonal health assessments. Corporate employees can also benefit from our Corporate Health Screening programmes designed to detect endocrine disorders early.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.

With over 20 years of trusted medical expertise in Singapore and comprehensive in-house diagnostic services, our team is equipped to provide the clarity you need. Book a Health Screening to investigate your symptoms and take the first step toward peace of mind.