Why do many people with adrenal insufficiency experience dizziness, racing heartbeats, or unstable blood pressure—even when heart tests appear normal?

In this episode, Jake and Rachel explore a new My Adrenal Life mini-series book by Rick Disler titled The Cardiovascular System in Adrenal Insufficiency: Understanding Circulation, Orthostatic Instability, Stress Physiology, and Early Warning Patterns.

Many patients with adrenal insufficiency experience symptoms such as dizziness when standing, rapid heart rate, internal tremors, or fluctuating blood pressure. Yet cardiac testing often shows the heart itself is structurally normal. This episode explains why those two things can both be true.

Rick Disler highlights an important concept: in adrenal insufficiency, most cardiovascular symptoms are regulatory rather than structural. The heart muscle is usually healthy, but the systems that control blood pressure, vascular tone, fluid balance, and autonomic responses can become unstable when cortisol—and in some cases aldosterone—are not functioning normally.

Cortisol plays a key role in helping blood vessels respond to stress hormones like epinephrine and norepinephrine. When cortisol levels are insufficient or poorly timed, blood vessels may not respond properly to changes in posture, heat, illness, or stress. This can lead to dizziness, poor circulation, or exaggerated heart rate responses.

The episode also explains how adrenal insufficiency affects blood pressure differently depending on the type. In Primary Adrenal Insufficiency (Addison’s disease), both cortisol and aldosterone may be low, which can lead to sodium loss, dehydration, and low blood pressure. In Secondary, Tertiary, or steroid-induced adrenal insufficiency, aldosterone is usually preserved, meaning blood pressure may remain normal or even elevated despite cortisol deficiency.

Jake and Rachel also discuss why symptoms can appear before major blood pressure changes occur. Even small reductions in blood flow to the brain can cause brain fog, dizziness, head pressure, or cognitive slowing.

Orthostatic instability—symptoms triggered when standing—is another common experience. Normally the body quickly adjusts blood flow when posture changes, but cortisol deficiency can make that adjustment slower or less effective.

Rick Disler also describes early warning patterns that may signal increasing cardiovascular strain, including unexplained fatigue, internal tremor, head pressure, or narrowing pulse pressure before more serious symptoms appear.

Understanding that adrenal insufficiency affects circulatory regulation rather than heart structure can help patients, caregivers, and clinicians better recognize symptoms and respond earlier.

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