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The outer layer produces aldosterone, a salt-balancing hormone that has effects on blood
pressure.
The middle layer produces cortisol, a hormone with effects on blood sugar, blood
pressure and inflammatory responses.
The deepest layer produces hormones called androgens, which have effects on growth of
sexual hair and acne, for example.
Normally, cortisol is produced and released by the adrenal cortex. Production of the hormone is
regulated by the hypothalamus and the pituitary gland. When the blood cortisol level falls, the
hypothalamus releases corticotropin-releasing hormone (CRH), which directs the pituitary gland
to produce ACTH (adrenocorticotropic hormone). ACTH stimulates the adrenal glands to
produce and release cortisol. In order for appropriate amounts of cortisol to be made, the
hypothalamus and both the pituitary and adrenal glands must be functioning properly.
Without enough cortisol or aldosterone, people become weak and dehydrated, unable to maintain
an adequate blood pressure or to respond properly to physical stress. Among its many roles,
cortisol affects the metabolism of carbohydrates, proteins, and fats, affects glucose levels in the
blood, acts as an anti-inflammatory agent, and helps the body react to stress such as infection or
trauma. Aldosterone is produced by the adrenal cortex and manages the salt and potassium
balance in the blood.
There are two different types of adrenal insufficiency and they depend on whether pituitary gland
or adrenal dysfunction underlies hormone deficiencies:
Addison disease is relatively rare. It affects about 1 person per 100,000 in the U.S. It is
found in people of all ages and affects both males and females equally. Symptoms of
insufficiency may not emerge until about 80% to 90% of the adrenal cortex has been
destroyed.
In the U.S., the most common cause (about 75%) of primary adrenal insufficiency in
adults is an autoimmune process. It may occur with other autoimmune conditions that
affect other glands, such as the thyroid. The rest of the time, Addison disease is due to
other causes, such as tuberculosis, a common cause in areas of the world where
tuberculosis is more prevalent, other chronic infections, especially fungal infections,
bleeding into the adrenal glands (hemorrhage) and the spread of cancer into the adrenal
glands. Rarely, it may be due to a genetic abnormality of the adrenal glands.
In children, about 70% of cases are caused by a congenital disease termed congenital
adrenal hyperplasia (CAH), while 30% of the time adrenal damage is due to autoimmune
disease, the inherited disease adrenoleukodystrophy, or less common causes.