Blood Pressure Myths in Adrenal Insufficiency

Why can someone feel like they’re about to collapse—yet their blood pressure reads “perfect” at the doctor’s office?

In this episode, Noah and Eloise explore a frustrating and confusing reality for many people living with adrenal insufficiency: vital signs that don’t always reflect how the body actually feels. Inspired by an article from My Adrenal Life, the conversation dives into why blood pressure and heart rate can fluctuate dramatically in adrenal insufficiency—and why a “normal” reading in a clinic may not tell the whole story.

Most people think of cortisol simply as the “stress hormone.” But in reality, cortisol plays a critical role in maintaining stability throughout the body. It helps regulate blood pressure, supports blood vessel function, manages inflammation, and allows the cardiovascular system to respond appropriately when we stand, walk, think, or experience stress.

Without enough cortisol, this system becomes unstable.

Eloise explains that cortisol helps maintain what doctors call vascular tone—the ability of blood vessels to tighten and relax properly. When cortisol levels are low, blood vessels may struggle to respond to signals that normally keep blood flowing to the brain, especially when a person stands up. This can lead to dizziness, fatigue, and sudden drops in blood pressure.

But the body doesn’t give up easily.

When cortisol is missing, the nervous system often compensates by releasing adrenaline and other stress hormones to keep blood pressure from crashing. This emergency response can cause rapid heart rate spikes, sudden blood pressure changes, and the familiar “wired but exhausted” feeling many patients describe.

The result can look like a roller coaster of vital signs—periods of low blood pressure followed by sudden spikes driven by adrenaline. What appears chaotic on the surface is actually the body struggling to maintain stability without one of its key regulators.

Noah and Eloise also explore how this process can differ depending on the type of adrenal insufficiency.

In primary adrenal insufficiency (Addison’s disease), the adrenal glands themselves are damaged. This often affects both cortisol and aldosterone, a hormone that helps the body retain salt and water. Without aldosterone, blood volume drops and severe low blood pressure becomes more common.

In secondary adrenal insufficiency, the pituitary gland fails to signal the adrenal glands to produce cortisol. Aldosterone levels may remain normal, meaning blood volume may appear stable—but the lack of cortisol can still lead to significant cardiovascular instability.

The episode also explains why medical appointments themselves can temporarily change vital signs. Activities like driving to the clinic, walking into the building, answering questions, and advocating for care can trigger an adrenaline surge. By the time a blood pressure reading is taken, the body may be in a stress response that temporarily masks underlying instability.

Because of this, Noah and Eloise discuss the importance of tracking patterns over time rather than relying on a single measurement. Monitoring blood pressure, heart rate, posture, activity, and symptoms throughout the day can reveal patterns that help explain crashes, fatigue, or dizziness that might otherwise be dismissed.

Ultimately, the conversation highlights a powerful message for people living with adrenal insufficiency: fluctuating vital signs are not imagined, and they are not a personal failure. They are often the body’s attempt to compensate for a missing hormone that normally keeps the cardiovascular system running smoothly.

Understanding the physiology behind these fluctuations can help patients, caregivers, and clinicians better recognize the patterns—and begin to manage them more effectively.

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