ACTH Deficiency

ACTH deficiency means the body does not make enough ACTH (adrenocorticotropic hormone), a hormone released by the pituitary gland in the brain. Low ACTH causes the adrenal glands to make too little cortisol, leading to “secondary adrenal insufficiency.” MSD Manuals+1

ACTH deficiency means the pituitary gland does not make enough ACTH (adrenocorticotropic hormone), so the adrenal glands do not make enough cortisol. This is called central or secondary adrenal insufficiency. People can feel very tired, weak, dizzy, sick, or have low blood sugar and low blood pressure. It may be caused by pituitary tumors, surgery, radiation, head injury, autoimmune disease, or long-term steroid use that shuts down ACTH. Treatment focuses on life-long cortisol replacement, education, and emergency planning to prevent adrenal crisis. MSD Manuals+3National Organization for Rare Disorders+3Wikipedia+3

Cortisol helps the body handle stress, keep blood pressure, blood sugar, and energy in balance. When ACTH is low for a long time, people can feel very tired, weak, dizzy, and may become seriously ill if not treated. National Organization for Rare Disorders+1

ACTH deficiency can be present from birth (congenital) or appear later in life (acquired). It may occur by itself (isolated ACTH deficiency) or together with other pituitary hormone problems. Wikipedia+1

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Another names

• Adrenocorticotropic hormone (ACTH) deficiency

• Isolated ACTH deficiency (IAD)

• Isolated adrenocorticotropic hormone deficiency

• Congenital isolated ACTH deficiency (CIAD)

• Central adrenal insufficiency due to ACTH deficiency

• Secondary adrenal insufficiency due to ACTH deficiency

These names all point to the same idea: the adrenal glands are underactive because the pituitary is not giving enough ACTH signal, not because the adrenal glands themselves are destroyed. National Adrenal Diseases Foundation+1

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Types

1. Congenital isolated ACTH deficiency
   This type is present from birth and is often caused by changes (mutations) in genes such as TBX19. Babies can have low blood sugar, long-lasting jaundice, or seizures very early in life. PMC+1

2. Acquired isolated ACTH deficiency
   In this type, only ACTH is low, but other pituitary hormones are normal. It may appear in adults with no clear cause or after damage to the pituitary. PMC+1

3. ACTH deficiency as part of combined pituitary hormone deficiency
   Here, ACTH is low together with other pituitary hormones such as TSH, LH, FSH, or growth hormone. This usually happens from pituitary tumors, surgery, radiation, or genetic pituitary problems. ScienceDirect+1

4. ACTH deficiency from hypothalamic (tertiary) disease
   In this group, the hypothalamus does not make enough CRH (corticotropin-releasing hormone), so ACTH from the pituitary falls. Long-term high-dose steroid use is a common cause of this situation. Healthline+1

5. Transient ACTH deficiency
   ACTH can be low for a limited time, for example after pituitary surgery or radiation. Over weeks to months, ACTH may slowly recover, so the deficiency is not permanent. www.elsevier.com+1

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Causes

1. Genetic TBX19 mutations
   Changes in the TBX19 gene can stop pituitary cells from making ACTH normally, causing congenital isolated ACTH deficiency in newborns and infants. PMC+1

2. Other congenital pituitary developmental defects
   Some babies are born with an under-developed pituitary gland, so it cannot make enough ACTH and sometimes other hormones as well. Frontiers+1

3. Pituitary adenomas (pituitary tumors)
   Benign tumors in the pituitary can squeeze normal hormone-producing cells and reduce ACTH secretion, leading to secondary adrenal insufficiency. ScienceDirect+1

4. Craniopharyngiomas and other sellar/parasellar tumors
   Tumors near the pituitary stalk or hypothalamus can disturb the signals that control ACTH release, so the adrenal glands no longer get enough stimulation. ScienceDirect+1

5. Pituitary surgery
   Operations to remove pituitary tumors or other lesions may damage ACTH-producing cells or the blood supply, causing a drop in ACTH after surgery. www.elsevier.com+1

6. Pituitary radiotherapy
   Radiation to treat pituitary or nearby brain tumors can slowly injure pituitary tissue, so ACTH levels may fall months or years after treatment. www.elsevier.com+1

7. Traumatic brain injury
   Head trauma can stretch or tear blood vessels and nerves around the pituitary, causing hypopituitarism with low ACTH in some patients. ScienceDirect+1

8. Pituitary apoplexy or hemorrhage
   Sudden bleeding or infarction inside a pituitary tumor can destroy hormone-producing tissue quickly, leading to acute ACTH deficiency and adrenal crisis. Bangladesh Journals Online+1

9. Sheehan syndrome (postpartum pituitary necrosis)
   Severe bleeding during or after childbirth can reduce blood flow to the pituitary so much that its cells die, often causing ACTH deficiency in young women. Bangladesh Journals Online+1

10. Autoimmune hypophysitis
    In this rare condition, the immune system attacks the pituitary gland, causing swelling and later scarring, which can reduce ACTH and other hormones. ScienceDirect+1

11. Infiltrative diseases (sarcoidosis, hemochromatosis, Langerhans cell histiocytosis)
    These systemic diseases can deposit cells or iron inside the pituitary or hypothalamus, damaging tissue and lowering ACTH production. ScienceDirect+1

12. Infections of the hypothalamus or pituitary (TB, meningitis, encephalitis)
    Chronic or severe infections in the brain region can destroy hormone-producing cells and disturb ACTH control. ScienceDirect+1

13. Long-term systemic glucocorticoid therapy
    Taking high-dose oral or injected steroids (like prednisone) for a long time tells the brain to “switch off” ACTH production; when steroids are stopped, ACTH deficiency and adrenal crisis can occur. Healthline+1

14. High-dose inhaled or topical steroids
    In some people, very high doses of inhaled or skin steroids are absorbed into the blood and suppress ACTH in a similar way to oral steroids. Healthline+1

15. Hypothalamic tumors or surgery (low CRH)
    Lesions in the hypothalamus may reduce CRH release, so the pituitary does not receive the proper signal to make ACTH, leading to low ACTH and cortisol. National Adrenal Diseases Foundation+1

16. Cranial irradiation for non-pituitary brain tumors
    Radiation used to treat leukemia or brain tumors in childhood can later damage the hypothalamus–pituitary axis, including ACTH secretion. ScienceDirect+1

17. Metastatic cancer to the pituitary
    Cancers from other organs can spread to the pituitary, destroying hormone-producing tissue and causing low ACTH. ScienceDirect+1

18. Empty sella syndrome
    In this condition, the pituitary is flattened or very small inside the sella turcica, sometimes leading to reduced ACTH and other pituitary hormones. ScienceDirect+1

19. Other genetic syndromes with pituitary hypoplasia
    Some rare genetic syndromes cause a small or malformed pituitary, so ACTH and other hormone levels are low from early life. Frontiers+1

20. Idiopathic (unknown cause)
    In some patients, ACTH deficiency is found but no clear structural, genetic, or immune cause can be identified; these cases are called idiopathic isolated ACTH deficiency. Wikipedia+1

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Symptoms

1. Ongoing tiredness and lack of energy
   People with ACTH deficiency often feel exhausted even after rest, because low cortisol makes it hard for the body to use energy and respond to stress. National Organization for Rare Disorders+1

2. Loss of appetite and weight loss
   Many patients eat less and lose weight slowly, sometimes without trying, due to chronic cortisol deficiency affecting metabolism and appetite. MSD Manuals+1

3. Nausea and vomiting
   Stomach upset, nausea, and vomiting are common, especially during stress or illness, and may be an early sign of adrenal insufficiency. MSD Manuals+1

4. Abdominal pain or discomfort
   Some people have vague belly pain, cramps, or discomfort that is hard to explain by other causes, which can delay the diagnosis. NIDDK+1

5. Dizziness, especially when standing up
   When cortisol is low, blood pressure control is weaker; standing up can cause a sudden drop in pressure, leading to dizziness or near-fainting. MSD Manuals+1

6. Low blood pressure and fainting
   Blood pressure may be low all the time, and some people collapse or faint, especially during infections, hot weather, or dehydration. National Organization for Rare Disorders+1

7. Muscle weakness and aches
   People may find it hard to climb stairs, carry groceries, or exercise, and can have aching muscles from chronic cortisol lack and electrolyte changes. MSD Manuals+1

8. Low blood sugar (hypoglycemia)
   Cortisol helps keep blood sugar normal; without it, people can have sweating, shakiness, confusion, or even seizures from low glucose, especially children. National Organization for Rare Disorders+1

9. Headache, confusion, or seizures
   Severe hyponatremia (low sodium) or hypoglycemia from ACTH deficiency can cause headaches, confusion, or seizures, particularly in babies and young children. PMC+1

10. Nervousness, irritability, or depression
    Mood changes such as irritability, low mood, or anxiety are common and may be mistaken for purely psychological problems before the hormonal cause is found. NIDDK+1

11. Salt craving
    Some patients crave salty foods, especially during hot weather or physical activity, because their bodies struggle with fluid and electrolyte balance. NIDDK+1

12. Pale skin and loss of body hair
    Unlike primary Addison’s disease, people with ACTH deficiency usually do not have darkening of the skin; they may look pale and can lose body hair due to reduced adrenal androgens. Mayo Clinic+1

13. Loss of periods and low sex drive in women
    Women may have irregular or absent menstrual periods and reduced interest in sex because ACTH deficiency often occurs with low other pituitary or adrenal sex hormones. NIDDK+1

14. Poor growth and delayed puberty in children
    Children with long-standing ACTH deficiency may not grow well or enter puberty at the expected age, especially if other pituitary hormones are also low. Orpha+1

15. Adrenal crisis (medical emergency)
    Without treatment, severe vomiting, very low blood pressure, shock, and unconsciousness can occur during stress or infection; this is called adrenal crisis and is life-threatening. National Organization for Rare Disorders+1

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Diagnostic tests

Physical exam tests

1. General physical examination
   The doctor looks at overall appearance, weight, hydration, and vital signs, searching for signs like thin body build, low energy, and poor general health that suggest adrenal insufficiency. MSD Manuals+1

2. Weight and BMI measurement
   Repeated weight checks and body mass index (BMI) help show slow, unexplained weight loss that fits with chronic cortisol deficiency. MSD Manuals+1

3. Blood pressure and pulse check
   Blood pressure and heart rate are measured at rest; low resting blood pressure or a fast pulse can point toward adrenal insufficiency from ACTH deficiency. MSD Manuals+1

Manual tests

4. Orthostatic (standing) blood pressure test
   Blood pressure and pulse are checked lying down and again after standing; a big drop in pressure or rise in heart rate suggests poor cortisol-related vascular control. Bangladesh Journals Online+1

5. Manual muscle strength testing
   The doctor tests arm and leg strength against resistance; reduced power or early fatigue may indicate chronic weakness from adrenal insufficiency. Ovid+1

6. Bedside neurological and mental status test
   Simple checks of alertness, memory, and coordination help detect confusion, slow thinking, or seizure history linked to hypoglycemia or hyponatremia from hormone deficiency. PMC+1

Lab and pathological tests

7. Morning serum cortisol test
   Blood is taken early in the morning to measure cortisol when it should be highest; a clearly low level strongly suggests adrenal insufficiency and triggers further testing. arupconsult.com+1

8. Plasma ACTH level
   ACTH is measured at the same time as cortisol; low ACTH with low cortisol points to ACTH deficiency (secondary adrenal insufficiency), while high ACTH suggests primary adrenal disease. MSD Manuals+1

9. Basic metabolic panel (sodium, potassium, glucose)
   Blood tests check electrolytes and glucose; low sodium and low glucose are common in ACTH deficiency, while potassium is usually normal, helping distinguish it from primary Addison’s disease. MSD Manuals+1

10. Specific blood glucose testing
    Fasting or random glucose measurements can show repeated low blood sugar episodes, especially in children and infants with congenital ACTH deficiency. PMC+1

11. Pituitary hormone panel
    Tests for TSH, free T4, prolactin, LH, FSH, sex hormones, and IGF-1 help decide if the problem is isolated ACTH deficiency or part of broader pituitary failure. ScienceDirect+1

12. Insulin tolerance test (insulin-induced hypoglycemia test)
    Insulin is given to lower blood sugar under close monitoring; in healthy people this strong stress raises cortisol, but in ACTH deficiency cortisol fails to rise properly. PMC+1

13. Short ACTH stimulation (Synacthen) test
    Synthetic ACTH is injected and cortisol is measured over time; a weak rise suggests adrenal damage, while a normal rise with low ACTH points more to a central (ACTH) problem, especially early on. PMC+1

14. Genetic testing for congenital ACTH deficiency
    In babies and children with very low ACTH and cortisol and no structural lesions, genetic tests (for example TBX19 mutations) can confirm congenital isolated ACTH deficiency. PMC+1

Electrodiagnostic tests

15. Electrocardiogram (ECG)
    An ECG checks the heart’s electrical activity and can show effects of low sodium or low glucose, such as rhythm problems, in severe ACTH deficiency. Bangladesh Journals Online+1

16. Electroencephalogram (EEG) in seizure cases
    An EEG records brain electrical signals and is useful if seizures occur from hypoglycemia or hyponatremia; it helps rule out other primary brain causes. PMC+1

Imaging tests

17. MRI of the pituitary gland
    MRI gives detailed pictures of the pituitary and surrounding tissues, showing tumors, inflammation, empty sella, or damage after surgery or radiation that could explain ACTH deficiency. Mayo Clinic+1

18. MRI or CT scan of the brain
    These scans look for hypothalamic tumors, metastases, bleeding, or structural defects affecting the hypothalamus–pituitary axis and ACTH control. ScienceDirect+1

19. CT or MRI of the adrenal glands
    Imaging of the adrenal glands helps tell primary adrenal disease from secondary ACTH deficiency; in ACTH deficiency, adrenal glands may appear small from under-stimulation. MSD Manuals+1

20. Abdominal ultrasound in newborns and infants
    In babies with suspected congenital ACTH deficiency, ultrasound can show signs such as enlarged liver or cholestatic jaundice, and helps rule out other causes of symptoms. Orpha+1

Non pharmacological treatments for ACTH deficiency

Because ACTH deficiency is a hormone-replacement disease, “non-drug” care mainly prevents adrenal crisis and improves daily life. To stay near your 3500-word limit, I will give 10 key non-pharmacological treatments in more compact form instead of 20, but they cover the most important therapies actually used in guidelines and patient leaflets.

1. Detailed patient and family education
Education is the most powerful non-drug therapy. The doctor or endocrine nurse explains what ACTH deficiency is, why cortisol is needed, how and when to take tablets, and what “sick day rules” mean. Patients learn early warning signs of adrenal crisis (severe weakness, vomiting, confusion) and when to seek urgent help. Good teaching reduces fear and helps people follow treatment every day, which is linked to fewer crises and better quality of life. endocrinology.org+2uhcw.nhs.uk+2

2. Sick-day rules and stress-dosing plans
People with ACTH deficiency need more cortisol during illness, fever, surgery, or big stress. Sick-day rules explain how to temporarily increase glucocorticoid doses and when to get an emergency injection and hospital care. Having a written plan at home and at school or work helps caregivers act fast if the person vomits or cannot take tablets. This structured plan is strongly recommended in adrenal insufficiency guidelines to prevent adrenal crisis. endocrinology.org+2adrenalinsufficiency.org+2

3. Medical alert bracelet and emergency card
Wearing a medical ID bracelet or necklace that says “Adrenal insufficiency – steroid dependent” is a simple but life-saving therapy. If the person is found unconscious, emergency teams can give stress-dose hydrocortisone straight away. Many endocrine and adrenal patient organizations advise wearing medical ID and carrying an emergency steroid card at all times. medicalert.org+2National Adrenal Diseases Foundation+2

4. Regular follow-up with an endocrinologist
Long-term follow-up visits allow the endocrinologist to adjust glucocorticoid dose, check blood pressure, weight, glucose, bone health, and look for other pituitary hormone problems. Doses that are too high may cause weight gain, diabetes, and bone loss, whereas too low doses risk fatigue and crisis. Modern guidelines stress that replacement should aim to copy normal circadian cortisol as closely as possible and should be reassessed regularly. PMC+2SpringerLink+2

5. Lifestyle planning and pacing of activities
Because fatigue and low stamina are common, pacing activity is important. People are encouraged to plan hardest tasks for when cortisol dose is highest (often morning), rest before and after heavy exercise, and avoid extreme over-training, which can stress the adrenal axis. Gentle, regular exercise improves mood, muscles, and bones without overloading the body. addisonsdisease.org.uk+2PubMed+2

6. Psychological support and stress-management therapy
Chronic illness, fatigue, and fear of crisis can cause anxiety or low mood. Psychological counseling, cognitive-behavioural therapy, or simple stress-reduction techniques (relaxation breathing, mindfulness, journaling) help people cope. Good mental health makes it easier to take medicines correctly and to respond calmly in emergencies. Some studies show that stress can trigger symptoms in adrenal disorders, so managing stress is part of overall care. PubMed+1

7. Nutrition counseling
Dietitians can advise about salt, fluids, calcium, vitamin D, and weight management. Some people with adrenal insufficiency need a bit more dietary sodium; others must avoid too much salted junk food if they also take fludrocortisone or have high blood pressure. Adequate calcium and vitamin D helps protect bones, which is important with long-term steroid therapy. NIDDK+2Medical News Today+2

8. School and workplace planning
For children and teenagers, teachers should know the diagnosis, regular medication times, and sick-day rules. For adults, occupational health or HR can help allow time for doses, snacks, or rest breaks, and access to toilets and water. Written workplace or school plans reduce stress and help others react quickly during illness. Patient organizations and endocrine societies often provide templates for such letters. Hormones Australia+2adrenalinsufficiency.org+2

9. Travel preparation and emergency kits
Before travel, patients are advised to carry extra tablets, an emergency injection kit if prescribed, and a doctor’s letter explaining the need for hydrocortisone and stress dosing. Keeping medicines in hand luggage and planning for different time zones helps prevent missed doses. Travel leaflets for adrenal insufficiency repeatedly stress carrying a steroid emergency kit and medical ID when away from home. National Adrenal Diseases Foundation+2adrenalinsufficiency.org+2

10. Vaccination and infection-prevention habits
Vaccination against common infections (for example influenza and pneumonia where recommended) and basic hygiene (hand-washing, safe food, prompt treatment of infections) reduce illnesses that can trigger adrenal crises. People on long-term glucocorticoids may have a higher infection risk, so preventive care is strongly encouraged in endocrine and steroid guidance documents. endocrinology.org+2FDA Access Data+2

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Drug treatments for ACTH deficiency

In ACTH deficiency, the main goal is to replace the missing cortisol with oral glucocorticoid medicine. Below are 8 key FDA-labelled drugs and formulations commonly discussed for adrenal insufficiency. They are examples only; the exact choice, dose, and timing must always be set by an endocrinologist.

1. Hydrocortisone tablets (Cortef and generics)
Hydrocortisone is the standard replacement drug because it is very similar to natural cortisol. Endocrine guidelines suggest a total daily replacement of about 15–25 mg in adults, split into 2–3 doses, usually a larger morning dose and smaller later doses to copy normal hormone rhythm. FDA labels for hydrocortisone tablets show a wider dose range (for many conditions), so the doctor individualizes the dosage based on symptoms, body size, and lab results. Side effects at higher doses include weight gain, high blood pressure, diabetes, mood changes, and bone thinning. Empendium+3FDA Access Data+3PMC+3

2. Pediatric hydrocortisone oral products (ALKINDI SPRINKLE, KHINDIVI, others)
Special hydrocortisone formulations such as ALKINDI SPRINKLE granules and KHINDIVI oral solution are designed for children with adrenal insufficiency so that very accurate small doses can be given. The FDA labels describe them as replacement therapy in paediatric patients and stress that they are not approved for emergency “stress dosing.” Doctors calculate doses by body surface area or weight, then adjust as children grow. These products improve dosing precision and can help avoid both under-replacement and steroid over-treatment in young patients. FDA Access Data+2FDA Access Data+2

3. Prednisone tablets (immediate- and delayed-release such as RAYOS)
Prednisone is a longer-acting glucocorticoid that can sometimes be used instead of hydrocortisone, especially when fewer daily doses are needed. Delayed-release formulations like RAYOS release the medicine later in the night to better match early-morning cortisol peaks for some inflammatory diseases, though for adrenal insufficiency doctors usually use individualized regimens. Prednisone is more potent than hydrocortisone, so replacement doses are lower (often equivalent to about 3–5 mg prednisolone daily in some guidelines). Side effects are similar to other steroids—weight gain, mood changes, blood pressure and glucose changes, and bone thinning—so the lowest effective dose is preferred. NICE+3FDA Access Data+3FDA Access Data+3

4. Prednisolone oral solution or tablets (for example Orapred)
Prednisolone is the active form of prednisone and is often used in children or people who need liquid medicine. FDA labels describe a wide initial dose range (0.14–2 mg/kg/day) for many conditions, but for ACTH deficiency, the endocrinologist uses much lower, long-term replacement doses tailored to age and size. Because prednisolone is more potent and long-acting than hydrocortisone, it may be given once or twice daily. Side effects with high or prolonged doses include growth slowing in children, infection risk, stomach irritation, and bone loss, so careful monitoring is essential. FDA Access Data+2SpringerLink+2

5. Modified-release hydrocortisone (where available)
Some countries use modified-release hydrocortisone tablets that release the hormone in a pattern closer to natural cortisol, especially higher levels in the early morning and lower levels at night. Studies suggest that more “physiologic” replacement may improve weight, blood pressure, and quality-of-life scores in some patients, although access and cost vary. Even with modified-release products, patients still need emergency stress-dose plans. The aim is to reduce the total steroid exposure while avoiding under-replacement. PMC+2SpringerLink+2

6. Dexamethasone tablets (Decadron, Hexadrol and others)
Dexamethasone is a very strong, long-acting glucocorticoid. Tablets such as Decadron contain small doses (0.5–0.75 mg) but have powerful effects on cortisol receptors. FDA information emphasizes that dosing must be individualized and that long-term use carries significant risks, including infection, muscle wasting, mood disturbance, and Cushingoid features. Because of its long half-life, dexamethasone can strongly suppress the hypothalamic-pituitary-adrenal axis, so it is usually avoided for routine replacement in ACTH deficiency and is reserved for special cases under expert care. NCBI+3FDA Access Data+3FDA Access Data+3

7. Cortisone acetate (where available)
Cortisone acetate is another oral glucocorticoid historically used for adrenal insufficiency and is converted to cortisol in the liver. Reviews on adrenal replacement describe typical adult doses of about 20–35 mg per day, divided into two or three doses, similar in total glucocorticoid effect to hydrocortisone 15–25 mg per day. It may be chosen based on local availability or cost. Side effects mirror other steroids and include metabolic and bone risks when the dose is too high. PMC+2SpringerLink+2

8. Fludrocortisone acetate tablets (Florinef and generics)
Fludrocortisone is a mineralocorticoid that replaces aldosterone, the hormone that controls salt and water balance. It is essential for many people with primary adrenal insufficiency, but is less often needed in pure ACTH deficiency because aldosterone is mostly controlled by the kidney hormone renin. The usual Addison’s disease dose is around 0.05–0.2 mg once daily, individualized to blood pressure and electrolytes. FDA-linked and other official labels warn about sodium retention, low potassium, and high blood pressure as important side effects, so doctors monitor salt intake, weight, and blood pressure carefully. HRES PDF+3DailyMed+3NCTR CRS+3

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Dietary molecular supplements

Supplements never replace prescribed steroids in ACTH deficiency, but they may support overall health, especially bones, muscles, and immunity. Always discuss supplements with a doctor or dietitian, because some products change steroid metabolism or blood pressure.

1. Calcium
Long-term glucocorticoid therapy can thin bones. Calcium supplements (for example 500–600 mg once or twice daily, depending on diet) help reach the recommended daily intake if food sources are low. Calcium supports bone mineralization and reduces bone loss when combined with vitamin D and weight-bearing exercise. Health agencies often advise total daily calcium from food plus supplements around 1000–1200 mg for many adults, but exact needs vary by age and local guidelines. Medical News Today+2HealthCentral+2

2. Vitamin D
Vitamin D helps the body absorb calcium and maintain bone strength. People on steroids often need vitamin D supplementation because glucocorticoids can lower bone density. Typical maintenance doses in adults are in the range of 600–1000 IU per day, but higher doses may be prescribed after deficiency is confirmed. Blood tests guide dosing to keep levels in the normal range, and this has been linked to lower fracture risk in steroid-treated patients. Medical News Today+2HealthCentral+2

3. Magnesium
Magnesium participates in hundreds of enzyme reactions, including bone and muscle function. Some diets are low in magnesium, and steroids may worsen muscle weakness and cramps. Modest magnesium supplements, adjusted for kidney function, can support muscle relaxation and energy metabolism. It is usually safer to increase magnesium-rich foods first (nuts, seeds, leafy greens), with supplements used under medical guidance to avoid diarrhoea or high blood levels in kidney disease. Healthline+2HealthCentral+2

4. Omega-3 fatty acids (fish oil)
Omega-3 fatty acids from fish oil or algae may help heart and blood vessel health, which is important because long-term steroids can raise blood pressure, lipids, and cardiovascular risk. Clinical reviews show that moderate omega-3 intake can reduce triglycerides and inflammation in some people. Typical supplemental doses range around 250–1000 mg EPA+DHA daily, but high doses must be supervised as they can increase bleeding risk in some patients. SpringerLink+2OUP Academic+2

5. B-complex vitamins
Fatigue is a major symptom of ACTH deficiency and adrenal insufficiency. While replacing cortisol is the main treatment, adequate B vitamins support red blood cell formation and energy metabolism. Many people can meet needs through a balanced diet, but a standard-dose B-complex supplement may be used if diet is poor or there are absorption issues. High-dose “adrenal booster” products should be avoided unless prescribed, as they may contain unregulated hormones or herbal stimulants. Wada-Ama+2OUP Academic+2

6. Vitamin C
Vitamin C acts as an antioxidant and supports immune function and collagen formation. Some small studies suggest that vitamin C, together with other antioxidants, may help reduce oxidative stress in chronic illness, but it does not replace cortisol. Typical safe supplemental doses are 100–500 mg per day in adults, as higher doses can cause stomach upset or kidney stones in susceptible people. A diet rich in fruits and vegetables usually gives enough vitamin C. Healthline+2NIDDK+2

7. Probiotics
Because oral steroids can affect the gut and immunity, probiotics are sometimes used to support gut microbial balance. Some trials show benefits for diarrhoea during antibiotic use and for certain inflammatory bowel conditions, but evidence in ACTH deficiency specifically is limited. A probiotic with clearly labelled strains and CFU count may be considered, but the choice should be guided by a clinician and should not promise to “cure adrenal fatigue,” which is not an accepted diagnosis. NIDDK+2Healthline+2

8. Sodium (salt) intake, when advised
Some people with adrenal insufficiency, especially when aldosterone is low, benefit from higher salt intake, while others do not. Patient leaflets explain that extra salt can help maintain blood pressure and prevent dizziness, but that heavily salted processed foods are still unhealthy. Using ordinary table or sea salt on home-cooked food, within limits set by the doctor, can be part of therapy. Decisions about targeted sodium intake are very individual. Mayo Clinic+3NIDDK+3addisonsdisease.org.uk+3

9. Potassium-rich foods (with care)
If a patient uses fludrocortisone or high doses of glucocorticoids, potassium can fall. Eating potassium-rich foods such as bananas, oranges, and certain vegetables may help keep levels normal. However, people with kidney disease or those on some blood-pressure medicines may need to limit potassium instead. Lab tests guide what is safe. DailyMed+2Cleveland Clinic+2

10. Protein-rich foods or supplements
Glucocorticoids can increase protein breakdown in muscles. Ensuring adequate protein intake from lean meats, dairy, eggs, beans, or (if needed) protein supplements helps maintain muscle mass and supports immune function. Dietitians often suggest spreading protein intake across meals and combining it with resistance exercise where appropriate. SpringerLink+2OUP Academic+2

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Regenerative, immunity-supporting and stem-cell related therapies

The request mentions “immunity booster, regenerative, stem cell drugs.” At present, there are no approved stem-cell or regenerative drugs that cure ACTH deficiency or regrow pituitary ACTH cells. Care must be taken not to trust unregulated “stem-cell clinics.” Below are supportive or research-level approaches, each needing specialist oversight.

1. Optimized glucocorticoid replacement as immune support
The most proven way to support immunity is to use the right amount of glucocorticoid—enough to prevent cortisol deficiency, but not so high that the immune system is suppressed. Studies in ACTH-deficient patients show that daily hydrocortisone doses above about 25 mg are linked to higher mortality and metabolic problems, probably partly due to immune and cardiovascular effects. So “immunity boosting” in this disease actually means fine-tuning steroid replacement, not taking extra unproven pills. OUP Academic+2PMC+2

2. Vaccination programs as immune protection
Regular vaccines against influenza, COVID-19, and pneumococcus (when recommended) do not boost immunity in a generic sense, but they protect against dangerous infections, which can be life-threatening in ACTH deficiency because they trigger adrenal crisis. Endocrine and adrenal patient guidelines advise following standard vaccination schedules and discussing extra vaccines based on age and risk. Wada-Ama+2endocrinology.org+2

3. Bone-protective drugs in selected patients
In some adults with long-term, higher-dose glucocorticoids and low bone density, doctors may prescribe bisphosphonates or similar osteoporosis medicines. They are not adrenal or stem-cell drugs, but they “regenerate” or preserve bone by reducing breakdown, lowering fracture risk. Their dosing schedules (for example weekly oral tablets) and side effects like stomach upset or rare jaw problems are detailed in their FDA labels and need careful monitoring. OUP Academic+2SpringerLink+2

4. Haematopoietic stem-cell transplantation in rare autoimmune syndromes (research context)
In a few rare immune disorders that damage endocrine glands, high-intensity immunosuppression followed by haematopoietic stem-cell transplant has been studied to “reset” the immune system. This is experimental, very high risk, and not a routine treatment for isolated ACTH deficiency. It is only done in specialist centres and usually for life-threatening multi-system diseases, not for standard adrenal insufficiency. Wada-Ama+2NCBI+2

5. Experimental pituitary cell and gene therapies
Laboratory research in animals is exploring how pituitary stem cells or gene therapy might restore hormone production, including ACTH, but this work is pre-clinical. There are no approved gene therapies or ACTH-producing cell implants for humans with pituitary failure. Any clinic that advertises such cures outside a formal trial should be treated with extreme caution. NCBI+2SpringerLink+2

6. General immune-support habits (sleep, exercise, nutrition)
Good sleep, balanced nutrition, moderate exercise, and mental health care are still the safest “immune boosters.” Research on adrenal insufficiency and exercise shows that over-training or extreme endurance sports without adequate cortisol coverage can worsen fatigue, while sensible, graded programs can improve stamina and mood. Healthy habits support the immune system and reduce infections without interfering with steroid replacement. addisonsdisease.org.uk+2PubMed+2

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Surgical management related to ACTH deficiency

Surgery does not cure ACTH deficiency in most cases, but it may treat the underlying pituitary or brain problem.

1. Transsphenoidal surgery for pituitary adenoma
If ACTH deficiency is caused by a non-functioning pituitary tumour pressing on normal gland tissue, surgeons may remove the tumour through the nose (transsphenoidal route). The goal is to relieve pressure, prevent further hormone loss, and reduce headache or vision problems. Even after successful surgery, many patients still need life-long cortisol replacement because the damaged ACTH cells do not fully recover. NCBI+2MSD Manuals+2

2. Surgery for craniopharyngioma or other sellar masses
Large benign brain tumours near the pituitary, like craniopharyngiomas, can cause multiple pituitary hormone deficiencies including ACTH. Neurosurgeons remove as much tumour as safely possible, sometimes combined with radiotherapy. Hormone replacement, including glucocorticoids, is usually permanent afterwards. The main “benefit” of surgery is to prevent neurological damage, not to restore ACTH. MSD Manuals+2NCBI+2

3. Decompression for pituitary apoplexy
Pituitary apoplexy is sudden bleeding into a pituitary tumour, causing severe headache, visual loss, and acute hormone failure including ACTH. Emergency high-dose IV hydrocortisone and sometimes urgent surgery to decompress the pituitary are required. Many patients are left with chronic ACTH deficiency that needs long-term replacement. NCBI+2MSD Manuals+2

4. Neurosurgical repair after traumatic brain injury
Severe head injury can damage the hypothalamus and pituitary, leading to ACTH deficiency. Neurosurgery may be needed to repair bleeding or fractures, but it does not specifically fix hormone cells. Later, endocrine assessment detects ACTH deficiency, and long-term hormone replacement is started. MSD Manuals+2ScienceDirect+2

5. Adrenal surgery in special situations
Sometimes people previously treated for Cushing’s syndrome (too much cortisol) by bilateral adrenalectomy or by pituitary surgery end up with permanent ACTH deficiency and adrenal insufficiency. The surgeries treat cortisol excess, but long-term glucocorticoid replacement is then required. Follow-up with an endocrinologist is critical to balance the risks of both too much and too little cortisol. Mayo Clinic+2MSD Manuals+2

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Prevention and self-care strategies

We cannot always prevent ACTH deficiency, but we can prevent many complications, especially adrenal crisis.

1. Avoid sudden stopping of long-term steroids
One of the most common causes of central adrenal insufficiency is abrupt withdrawal of high-dose glucocorticoids used for other diseases. Doctors stress tapering slowly so the hypothalamus and pituitary can recover. Patients should never stop long-term steroids suddenly without medical supervision. MSD Manuals+2ScienceDirect+2

2. Follow sick-day and surgery rules
Using sick-day rules during infections, vomiting, or surgery helps prevent cortisol shortage and crisis. Written instructions for doubling or tripling oral doses temporarily, and when to seek injections, are a core preventive tool. addisonsdisease.org.uk+2endocrinology.org+2

3. Wear medical identification
Wearing a medical alert bracelet or card is strongly recommended so first responders know to give stress-dose steroids immediately if collapse or severe illness occurs. This can prevent shock and death from untreated adrenal crisis. medicalert.org+2National Adrenal Diseases Foundation+2

4. Keep medicines available and in date
Patients should keep enough hydrocortisone and other prescribed hormones at home, school, and when travelling, and check expiry dates on tablets and any emergency injection kits. Running out of medicine is a preventable cause of crisis. National Adrenal Diseases Foundation+2adrenalinsufficiency.org+2

5. Manage infections early
Because infections are a major trigger of crisis, people with ACTH deficiency are told to seek care early for fevers, vomiting, or severe diarrhoea. Early antibiotics or antiviral treatment when appropriate, together with stress dosing, reduces severe illness risk. Wada-Ama+2endocrinology.org+2

6. Maintain a balanced diet and healthy weight
A diet rich in whole foods, adequate protein, and enough calcium and vitamin D supports bones and metabolism while on steroids. Staying close to a healthy weight lowers blood pressure and diabetes risk, which can be increased by glucocorticoids. SpringerLink+3NIDDK+3Medical News Today+3

7. Regular exercise but avoid extreme over-training
Moderate, regular exercise improves heart health, mood, and bones. Over-training without proper steroid and fluid management may worsen fatigue and stress the adrenal axis, so activity plans should be gradual and sensible. addisonsdisease.org.uk+2PubMed+2

8. Protect bone health
In addition to diet and exercise, doctors may recommend periodic bone density scans and, in high-risk patients, osteoporosis medicines. This preventive approach aims to catch bone loss early before fractures occur. OUP Academic+2SpringerLink+2

9. Plan pregnancies with specialist care
For people who may become pregnant, planning pregnancy with an endocrinologist and obstetrician helps adjust hormone doses safely and prepare for stress-dosing during labour. Pituitary conditions and adrenal insufficiency need careful monitoring in pregnancy to prevent complications. NCBI+2National Organization for Rare Disorders+2

10. Stay in regular specialist follow-up
ACTH deficiency is usually life-long. Regular reviews allow early detection of other pituitary hormone problems, dose adjustments, and updated sick-day guidance. This continuing care is one of the best ways to prevent serious complications over time. SpringerLink+2Empendium+2

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When to see doctors or go to emergency care

1. New or worsening fatigue and weakness
If someone with ACTH deficiency notices increasing fatigue, muscle weakness, or difficulty coping with normal activities, they should contact their endocrinologist or family doctor. These may be signs that the replacement dose is too low or that another illness or hormone problem has developed. National Organization for Rare Disorders+2Wada-Ama+2

2. Repeated low blood sugar symptoms
Shaking, sweating, hunger, or confusion can signal low blood sugar in ACTH deficiency, especially in children. Recurrent episodes need medical review to check cortisol dosing and meal patterns and to rule out other causes of hypoglycaemia. National Organization for Rare Disorders+2Wada-Ama+2

3. Dizziness, fainting, or very low blood pressure
Frequent dizziness when standing, fainting, or very low blood pressure readings may show that cortisol or aldosterone replacement is not adequate, or that salt intake is too low. This needs prompt medical assessment and lab tests for electrolytes and renin. MSD Manuals+2NIDDK+2

4. Signs of adrenal crisis – emergency care
Sudden severe weakness, vomiting, extreme abdominal pain, confusion, or collapse are warning signs of adrenal crisis and are a medical emergency. Emergency services should be called, and emergency steroid treatment given as per local protocols. Patients and families are taught to treat this as “call an ambulance now” level serious. Pituitary Foundation+3Wada-Ama+3GGC Medicines+3

5. Persistent vomiting or diarrhoea
If a person with ACTH deficiency cannot keep tablets down due to vomiting or has ongoing diarrhoea, oral steroids may not be absorbed. They should seek urgent medical care for injectable steroids and IV fluids, following sick-day rules. addisonsdisease.org.uk+2adrenalinsufficiency.org+2

6. Planned surgery or procedures
Any planned operation, endoscopy, or dental procedure with sedation must be discussed with the endocrine team in advance. Extra steroid cover is needed during and after procedures, and hospitals have protocols to prevent adrenal crisis. worcsacute.nhs.uk+2uhcw.nhs.uk+2

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What to eat and what to avoid

1. Eat: balanced meals with whole foods
People with ACTH deficiency are advised to follow a balanced diet with fruits, vegetables, whole grains, lean proteins, and healthy fats. This supports general health, energy, and blood sugar control, which can be affected by glucocorticoids. NIDDK+2Healthline+2

2. Eat: enough calcium and vitamin D sources
Foods rich in calcium (dairy, fortified plant milks, leafy greens) and vitamin D (fatty fish, fortified foods) help protect bones. Many people on long-term steroids need extra focus on these nutrients to lower fracture risk. Medical News Today+2HealthCentral+2

3. Eat: adequate protein
Lean meats, fish, eggs, beans, and lentils provide protein to support muscles and immunity. Because steroids can increase protein breakdown, spreading protein intake through the day can help maintain strength. SpringerLink+2Healthline+2

4. Eat: moderate complex carbohydrates
Whole grains, beans, and starchy vegetables provide steady energy and help stabilize blood sugar. This is helpful because both cortisol lack and steroid therapy can affect glucose control. Sugary drinks and sweets should be limited to prevent spikes. Healthline+2NIDDK+2

5. Eat: salt as advised by your specialist
Some people with adrenal insufficiency benefit from slightly higher salt intake, especially if aldosterone is low and blood pressure is low. Others, particularly on fludrocortisone or with high blood pressure, must be more careful. Doctors often suggest using normal salt on food but avoiding very salty processed snacks. Cleveland Clinic+3NIDDK+3addisonsdisease.org.uk+3

6. Avoid: heavily processed, very salty foods (unless specifically advised)
Even when extra salt is needed, heavily processed foods like instant noodles, crisps, and fast food can give too much sodium and too little nutrition, and may raise blood pressure. Patient diet advice for Addison’s disease recommends focusing on healthier sodium sources rather than junk food. Raymond A. Wood Foundation+2addisonsdisease.org.uk+2

7. Avoid: excessive sugar and refined carbs
Steroids can raise blood sugar and increase diabetes risk. Limiting sugary drinks, sweets, and refined bread or pastries helps protect metabolic health. Choosing fibre-rich carbs instead leads to more stable energy and better weight control. Healthline+2OUP Academic+2

8. Avoid: excessive caffeine and energy drinks
High caffeine intake may worsen palpitations, anxiety, and sleep problems, which already affect some people with adrenal insufficiency. Large caffeine loads can also make it harder to tell if symptoms are from cortisol lack or stimulant use. Moderate tea or coffee is usually acceptable, but energy drinks are best avoided. Healthline+1

9. Avoid: heavy alcohol use
Alcohol can upset blood sugar control, worsen dehydration, and mask early symptoms of adrenal crisis. It can also interfere with liver metabolism of steroids. Many guidelines suggest keeping alcohol within general public health limits or avoiding it if it clearly worsens symptoms. Healthline+2OUP Academic+2

10. Avoid: unregulated “adrenal booster” or steroid-like supplements
Some online products marketed as “adrenal support” contain unlabelled steroid hormones or high-dose stimulants, which can dangerously interfere with prescribed therapy and further suppress ACTH. Endocrine specialists warn against such supplements; any new product should be checked with a doctor first. endocrinology.org+2Wada-Ama+2

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Frequently asked questions (FAQs)

To respect your word limit, here are 10 key FAQs instead of 15, focusing on simple, search-friendly explanations.

1. Is ACTH deficiency the same as Addison’s disease?
No. Addison’s disease is primary adrenal insufficiency, where the adrenal glands themselves are damaged. ACTH deficiency is secondary adrenal insufficiency, where the pituitary or hypothalamus fails to signal the adrenals. Symptoms overlap because both lead to low cortisol, but causes and some treatments differ. National Organization for Rare Disorders+2MSD Manuals+2

2. Can ACTH deficiency be cured?
In most people, ACTH deficiency is long-term or permanent, especially after pituitary surgery, radiation, or longstanding tumor damage. A few cases due to temporary steroid suppression or short-term illness may improve over months, but this must be tested carefully by an endocrinologist. For safety, patients usually stay on replacement until tests show full recovery. MSD Manuals+2ScienceDirect+2

3. What is the main treatment for ACTH deficiency?
The core treatment is daily glucocorticoid replacement, usually with hydrocortisone or sometimes prednisone/prednisolone in doses chosen to mimic normal cortisol. Patients also need education about sick-day rules and emergency stress doses during illness or surgery. This combination has been shown to reduce adrenal crises and improve quality of life when followed correctly. adrenalinsufficiency.org+3Empendium+3PMC+3

4. Will I need mineralocorticoid (fludrocortisone) as well?
Most people with pure ACTH deficiency do not need fludrocortisone because aldosterone is regulated mainly by the kidney hormone renin, not ACTH. It is more common in primary adrenal failure. However, your doctor will check sodium, potassium, blood pressure, and renin to decide whether you need it. MSD Manuals+2DailyMed+2

5. Can I live a normal life with ACTH deficiency?
Many people live full, active lives when they take replacement steroids correctly, understand sick-day rules, and wear medical ID. Examples of athletes and workers with adrenal insufficiency show that the condition can be well managed, though it needs daily attention and emergency planning. National Adrenal Diseases Foundation+2National Adrenal Diseases Foundation+2

6. Is ACTH deficiency dangerous in children and teenagers?
Yes, untreated ACTH deficiency can be life-threatening at any age, but with proper hydrocortisone replacement, sick-day plans, and growth monitoring, children and teenagers can grow and develop normally. Special paediatric hydrocortisone products help give accurate small doses. Schools and caregivers should be educated about emergency care. addisonsdisease.org.uk+3FDA Access Data+3Medscape+3

7. How often should hormone levels be checked?
The exact schedule varies, but many people are reviewed at least yearly, and more often after diagnosis or dose changes. Doctors may check morning cortisol (if testing recovery), ACTH, electrolytes, glucose, lipids, bone density, and other pituitary hormones, adjusting doses based on symptoms and labs rather than one test alone. UpToDate+3Empendium+3SpringerLink+3

8. Can I get pregnant if I have ACTH deficiency?
Many people with central adrenal insufficiency can have successful pregnancies with close endocrine and obstetric care. Glucocorticoid doses often need adjustment during pregnancy and delivery, and stress-dose steroids are given in labour. It is important to plan pregnancy and review all medicines beforehand. NCBI+2National Organization for Rare Disorders+2

9. What is an adrenal crisis and how can I avoid it?
An adrenal crisis is a severe, life-threatening drop in cortisol, usually triggered by illness, vomiting, trauma, or surgery. Symptoms include extreme weakness, vomiting, abdominal pain, low blood pressure, and confusion. Prevention relies on daily replacement, sick-day rules, early treatment of illness, and rapid access to emergency hydrocortisone. adrenalinsufficiency.org+3GGC Medicines+3uhcw.nhs.uk+3

10. Should I change my medicine doses by myself?
No. Except for specific written sick-day instructions, dose changes should always be made with your endocrinologist or specialist nurse. Self-adjusting daily doses or adding over-the-counter “adrenal boosters” can cause serious harm and make it harder for doctors to judge your real hormone needs. endocrinology.org+2OUP Academic+2

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: December o2 , 2025.