Hi, The circumstances and diseases that trigger low cortisol, or hypoadrenalism, vary. Besides the autoimmune disorder Addison’s disease, other causes include secondary hypoadrenalism, or a deficiency of ACTH. Secreted from the anterior pituitary gland, ACTH, or adrenocorticotropic hormone, is a polypeptide tropic hormone that elevates its production when the body suffers from low cortisol levels as a result of Addison’s disease. It’s possible for the body to develop a tumor as the result of increased ACTH, known as Cushing’s disease. Another cause is tuberculosis. Tuberculosis is an infectious disease that usually attacks the lungs, but can also affect the adrenal glands and trigger hypoadrenalism. If the disease destroys the adrenal glands, it is irreversible. Other rare disorders that can damage the adrenal glands and trigger low cortisol levels are: 1. Adrenal inflammation related to HIV 2. Congenital adrenal hyperplasia, an enzyme disorder 3. Amyloidosis 4. Bilateral adrenalectomy 5. Adrenoleukodystrophy 6. Sarcoidosis 7. Metastases Treatment: If a patient is diagnosed with low cortisol levels, they will most likely be prescribed oral hydrocortisone tablets as replacement therapy. Patients will have to regularly track the levels of cortisol in their blood throughout the day, starting from before their first daily dosage. A hydrocortisone regimen is designed to imitate the body’s natural levels of cortisol throughout the day, starting out high in the early morning and decreasing as the day goes on. Cortisol supplements should only be taken for cases of severe cortisol deficiency, caused by serious disorders such as Addison’s or tuberculosis. If synthetic cortisol is taken when low cortisol levels are not severe enough to warrant it, this can result in a loss of natural cortisol production in the adrenal glands. Patients who see a decrease in their adrenal gland’s natural cortisol production will actually need to take extra cortisol during times of particular stress or activity, such as an illness, to make up for the lowered levels. People with mild cortisol deficiency should take extra measures in their life to reduce and prevent unmanageable levels of stress, which is one of the primary causes of low cortisol. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Sanjay Kini, General & Family Physician