Different types of adrenal insufficiency:

Primary: there is a problem of the adrenal glands themselves (this is called Addison's disease).

Secondary: there is a problem of the pituitary gland (located in the brain).

Tertiary: there is a problem with the hypothalamus (located in the brain)

Steroid-induced insufficiency: due to medication containing a synthetic form of cortisol (also called tertiary adrenal  insufficiency).

Symptoms of adrenal insufficiency mainly include:

Brown discoloration of the skin (primary)

General weakness, accompanied by fatigue

Weight loss due to reduced appetite

Salt hunger (primary)

Gastrointestinal complaints such as: nausea/vomiting and abdominal pain, diarrhea;

Pain in the muscles and joints;

Brain fog (concentration and attention problems;

Depressive complaints;

Low blood pressure and/or blood sugar;

Unexplained fever;

Flank pain (suspected dehydration);

Problems waking up (disturbed sleep and wake rhythm).

Diagnosing the condition is a considerable process that the patient must take, in some cases it may be too late due to the sudden onset of an Addisonian crisis when 90% of the adrenal glands are destroyed.

The road to diagnosis is difficult because adrenocortical insufficiency is a rare condition (primary).

Many preliminary investigations can be carried out to rule out other possible conditions, including psychological problems and the appointment of a dietician.

If the complaints persist, further investigation is carried out such as a blood analysis and referral to a specialist, endocrinologist.
This will conduct further research into the cortisol values, and if they deviate, further tests will be done.
There are two types of tests to see cortisol production, an ITT (insulin intolerance test) and an ACTH test (also called the synacthen test).

Furthermore, a brain scan of the pituitary gland/hypothalamus or genetic testing can be performed if indicated.

When the condition is diagnosed, based on the type of adrenocortical insufficiency, replacement synthetic cortisol (hydrocortisone) will be started immediately, the dose of which will be determined by the endocrinologist.
It can sometimes take years before the correct dose adjustment is achieved and the patient will be almost completely free of complaints.

In some cases, such as primary adrenocortical insufficiency, multiple medications are prescribed, such as the hormone DHEA and fludrocortisone.

Different types of corticosteroids:

Hydrocortisone (Solu Cortef for SC/IV/IM administration): fast-acting corticosteroid

Prednisone: slow-acting corticosteroid, mainly used for infections/inflammations

Dexamethasone: mainly used for infections/inflammations

Aldosterone (fludrocortisone): a hormone (mineralcorticoid) produced by the adrenal gland.It plays an important role in regulating blood pressure (fluid-salt axis).

DHEA: Dehydroepiandrosterone, a hormone produced by the adrenal gland.

It is converted into androgen and estrogen in both men and women.

In primary or secondary adrenal insufficiency, an underactive thyroid gland (Hashimoto's/hypothyroidism) is also often diagnosed, usually some time after the diagnosis of adrenal insufficiency.

Other conditions that may be related are celiac disease, type 1 diabetes, Graves' disease.