Addison’s disease, also called primary adrenal insufficiency, is a rare disorder that occurs when the body doesn’t make enough of two hormones called cortisol and aldosterone.
Cortisol is an essential hormone that helps your body respond to stress and regulates blood pressure, blood sugar levels, heart function, and immune system function. Aldosterone helps regulate the balance of sodium and potassium in your blood, which in turn helps regulate blood pressure.
Addison’s disease is caused by damage to the adrenal glands — two small, triangular glands that sit above the kidneys and produce cortisol, aldosterone, and, to a lesser degree, sex steroids. Symptoms can start slowly and may include extreme fatigue, weight loss, and cravings for salt, among others. Medication is needed to manage Addison’s disease. If left untreated, it can be deadly.
The symptoms of Addison’s disease may develop slowly over time, and some people miss or ignore early symptoms. The symptoms are also common to many different health issues, which can result in delayed diagnosis.
Sometimes the symptoms of Addison’s disease can progress quickly and lead to an adrenal crisis (Addisonian crisis), a life-threatening emergency that requires immediate medical attention. If you experience any of the following symptoms of an adrenal crisis, call 911 immediately:
Extreme weakness
Fever
Dehydration
Severe pain in the lower back, abdomen, or legs that comes on quickly
Changes in mental status, such as feeling restless, confused, or afraid
Severe vomiting or diarrhea
Low blood pressure
Fainting or loss of consciousness
Several factors can lead to an adrenal crisis, including:
Damage to the adrenal glands from a disease or surgery
Abruptly stopping treatment with glucocorticoids like prednisone
Trauma
Childbirth
Surgery
Addison’s disease is caused by damage to the outer layer of the adrenal glands. Autoimmune diseases — conditions that happen when the body’s immune system mistakenly attacks healthy organs and tissues — are the most common cause of this damage. In the case of Addison’s disease, the immune system mistakenly attacks the adrenal glands.
Surgical removal of the adrenal glands, which may be done to treat another health problem
Genetic conditions that impact how the adrenal glands develop or function
Certain medications, such as some antifungals or general anesthesia medications
Most people don’t have any risk factors that boost their odds of developing Addison’s disease. In some cases, the following factors may raise a person’s risk:
A disease or surgery that affects the adrenal glands
Amyloidosis (a condition involving buildup of amyloid proteins in vital organs, leading to damage)
A rare genetic disease
If your healthcare provider suspects you have Addison’s disease, they may order the following tests:
Blood tests to check your sodium, potassium, cortisol, renin, aldosterone, and adrenocorticotropic hormone (ACTH) levels
ACTH stimulation test to measure the response of your adrenal glands after an injection of artificial ACTH
An imaging scan, such as computed tomography (CT), to determine if your adrenal glands are damaged or infected
The only treatment for Addison’s disease is medication to correct levels of cortisol and aldosterone in the body. Cortisol is replaced with a synthetic version, such as hydrocortisone (Cortef), prednisone (Prednisone Intensol, Rayos) or methylprednisolone (Medrol). Aldosterone is replaced with a synthetic version called fludrocortisone acetate.
Addison’s disease is a lifelong condition, so you’ll need to take these medications for the rest of your life.
Dosages of these medications vary from person to person, and your doctor may tell you to take more or less of them during certain times in your life. For example, if you are sick or scheduled to have surgery, your doctor may tell you to take more of these medications because more of these hormones are needed when your body is under stress.
You may also need to up your sodium intake while taking these medications, especially during heavy exercise, hot weather, or if you’re having digestive issues such as diarrhea.
It’s important for your healthcare team to closely monitor the dosages of your medication to ensure you’re not taking too much or too little. Too much hydrocortisone, for example, can lead to type 2 diabetes, obesity, or osteoporosis over time. Too much fludrocortisone can lead to high blood pressure.
As mentioned, an Addisonian crisis or adrenal crisis is a medical emergency. Treatment may involve intravenous medication or solutions such as corticosteroids, saline solution, or sugar.
There’s no way to prevent Addison’s disease. But there are ways to keep yourself healthy after you’re diagnosed with this condition:
Take your medications as prescribed to prevent complications. Missing even one day of your medications can be dangerous, so it’s a good idea to keep extra medication on you at all times.
Have an emergency corticosteroid medication kit with you at all times to provide the hormones you need if you begin to develop emergency symptoms. These kits include injectable corticosteroids that act fast in the body.
Carry a medical alert card or bracelet with you so emergency personnel will know how to help you if you ever experience extreme symptoms.
Attend regularly scheduled checkups and blood draws to keeps tabs on your symptoms and hormone levels and make sure you stay healthy. You need to monitor your hormone levels carefully to avoid taking too much or too little medication.
As mentioned, Addison’s disease is a lifelong condition with no cure. But with daily medication, people with Addison’s disease often go on to live healthy, normal lives.
Addison’s disease may lead to other issues that require medical intervention, including:
Adrenal crisis
Low blood pressure
Low blood sugar
High potassium levels in the blood
Addison’s disease remains a very rare condition, affecting only 1 in 100,000 people in the United States. It can affect anyone, but it’s most common in people ages 30 to 50. It’s also more commonly diagnosed in people with other autoimmune disorders, including:
Addison’s disease is a rare condition in which the adrenal glands do not produce enough of the hormones cortisol and aldosterone, which play essential roles in various bodily functions.
It’s most often caused by an autoimmune condition in which the immune system mistakenly attacks and damages the adrenal glands.
A lifelong condition, Addison’s disease requires daily medication to ensure the body has enough cortisol and aldosterone.
