Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentCoping
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Coping
Addison’s disease, also known as primaryadrenalinsufficiency and hypocortisolism, is a rare disorder in which the adrenal glands (which sit atop the kidneys) don’t produce enough of the hormonescortisoland sometimesaldosterone.
Symptoms tend to come and go and may include abdominal pain, dizziness, fatigue, weight loss, salt cravings, and darkening of the skin.During periods of extreme stress or poor health, Addison’s disease can trigger a rapid drop in cortisol levels and a potentially life-threatening event known as anadrenal crisis.
The most common cause of Addison’s disease is autoimmune adrenalitis, a disorder in which the body’s immune system inadvertently attacks and damages cells of the adrenal glands.
While Addison’s disease can be diagnosed with blood and imaging tests, it is so rare—affecting only 1 of every 100,000 people—that diagnoses are typically delayed until more serious manifestations of the disease develop.
Addison’s disease cannot be cured but can be significantly improved with hormone replacement therapy and the avoidance of common triggers. If treated properly, Addison’s disease can be brought under control and you can be better assured of living a long and healthy life.
This article discusses the causes, symptoms, and diagnosis of Addison’s disease, with some added tips for living with this chronic condition.
JR Bee / Verywell
What Are the Symptoms of Addison’s Disease?
The primary symptoms of Addison’s disease tend to be episodic and non-specific. Common symptoms include:
The symptoms of Addison’s disease are directly associated with the degree of adrenal impairment. As a progressive disease, the symptoms tend to worsen over time if left untreated.
They can start incidentally, with odd moments of stomach pain and weakness, but become increasingly more apparent as the attacks recur, particularly during moments of stress.
Depending on the cause of the underlying impairment, the symptoms of Addison’s disease can either develop slowly and steadily or fast and furiously.
The majority of symptoms are caused when a drop in cortisol levels (hypocortisolism) triggers an associative drop in blood pressure (hypotension) and blood sugar (hypoglycemia). Other symptoms are related to a drop in aldosterone, the hormone responsible for sodium retention.
Adrenal Crisis
Adrenal crisis, also known as an Addisonian crisis, occurs when cortisol levels have dropped so rapidly that it causes serious and potentially life-threatening symptoms, including:
If not treated aggressively with intravenous fluids and steroids, death may ensue, most often as a result ofhypotensive shockorrespiratory failure. According to research, an adrenal crisis results in death in one of every 16 cases, most often due to delayed or inadequate treatment.
What Are the Causes of Addison’s Disease?
Kidneys and adrenal glands. Computer illustration of human kidneys (red), showing the position of the adrenal glands (yellow).SCIENTIFICANIMATIONS.COM / SCIENCE PHOTO LIBRARY/Getty Images
SCIENTIFICANIMATIONS.COM / SCIENCE PHOTO LIBRARY/Getty Images
Cortisol, often referred to as the “stress hormone,” rises when the “fight or flight” instinct is triggered during a crisis. It also plays a central role in the regulation of blood pressure, blood sugar, protein, fat, and carbohydrate metabolism, bone mineralization and density, inflammation, sleep, and energy levels. It is produced in a part of the adrenal glands known as thezona fasciculata.
Addison’s disease develops when the adrenal glands can no longer adequately supply the body with cortisol and aldosterone. It affects men and women equally and occurs in all age groups, but is most common between the ages of 30 and 50.
Risk Factors for Addison’s Disease
Risk factors for the most common type of Addison’s disease (autoimmune) include other autoimmune diseases:
Adrenal Impairment
By far the most common cause of this is autoimmune adrenalitis, anautoimmune diseasein which the body turns its defenses on itself and attacks the cells in the adrenal glands that produce steroids.No one is exactly sure why this happens, although genetics are believed to play a central role.
In addition to autoimmune adrenalitis, other conditions can directly impact the adrenal glands, including:
Rare genetic disorders like Smith-Lemli-Opitz syndrome (an inborn error affecting cholesterol synthesis) andabetalipoproteinemia(which interferes with the absorption of fat) are among some of the inherited disorders that can indirectly lead to Addison’s disease.
An adrenal crisis can occur as either an extension of Addison’s disease or independent of it. More specifically, an adrenal crisis develops when the drop in cortisol is rapid and severe, leading tolow blood pressure, low blood sugar, and high blood levels of potassium. The condition is potentially life-threatening and requires immediate medical care.
Other studies have also supported gastrointestinal illness as the predominant trigger for an acute adrenal crisis. Other causes include seizures, severe migraine, hot weather, atrial fibrillation (irregular heartbeat), and even long-distance flights. Additional risk factors include pregnancy and diabetes.
Secondary Adrenal Insufficiency
An adrenal crisis can also occur if thepituitary glandis damaged or diseased. The pituitary gland is part of the hypothalamic-pituitary-adrenal axis. Its role is to “instruct” the adrenal gland when to produce more cortisol and how much. It does so with a hormone calledadrenocorticotropichormone (ACTH).
Another common cause of secondary adrenal insufficiency is the sudden termination ofcorticosteroid drugsused to treat arthritis, asthma, and other inflammatory diseases.By stopping the drugs abruptly, undiagnosed Addison’s disease may be inadvertently “unmasked” in the form of an adrenal crisis.
How Is Addison’s Disease Diagnosed?
Addison’s disease is diagnosed with a variety of blood and imaging tests used to confirm adrenal insufficiency. A diagnosis is typically initiated based on the appearance of telltale symptoms, such as hyperpigmentation, fatigue, and salt cravings (a classic triad of adrenal symptoms).
In others, a routine blood test may reveal abnormalities suggestive of the disease, such as the unexplained recurrent episodes of hypoglycemia, hyponatremia, and hypokalemia.
More commonly, an adrenal crisis will be the first symptom of Addison’s disease in around 50% of cases.
Tests Used to Diagnose Addison’s DiseaseSerum cortisol testsACTH stimulation testAutoantibody studiesInsulin-induced hypoglycemia testImaging tests
Tests Used to Diagnose Addison’s Disease
Serum cortisol testsACTH stimulation testAutoantibody studiesInsulin-induced hypoglycemia testImaging tests
Additional investigations may be needed to exclude all other causes of adrenal insufficiency—a process known as thedifferential diagnosis. Other possible causes includehyperthyroidism(overactive thyroid),lymphoma, anorexia nervosa,hemochromatosis(iron overload), and adrenal suppression due to corticosteroid therapy.
How Is Addison’s Disease Treated?
Among those most commonly prescribed:
As with many medications, there are several common side effects of those commonly prescribed to treat Addison’s disease including:
Long-term use may causelipodystrophy(the redistribution of body fat) andosteoporosis(bone thinning), although these are more likely due to overmedication than the duration of treatment.
Grapefruit and licorice can also amplify side effects and should be consumed sparingly. Speak to your healthcare provider if the side effects are intolerable or causing you distress. In some cases, treatment can be changed or the dosages reduced.
If you have Addison’s disease, you will likely be advised to wear a medical ID bracelet in the event of an adrenal crisis. Moreover, you will likely be advised to carry an emergency kit containing a needle, syringe, and a 100-milligram ampule of injectable hydrocortisone.
In the event of vomiting, persistent diarrhea, or other symptoms of an adrenal crisis, seek emergency without delay.
As an adrenal crisis can progress rapidly, you would need to give yourself an emergency intramuscular injection of hydrocortisone until help arrives. This requires that you or a family member learn proper injection techniques and recognize the signs and symptoms of an adrenal crisis.
Giving too much hydrocortisone in an emergency situation will do no harm. By contrast, under-dosing will do little to prevent the rapid deterioration of your condition. An adrenal crisis requires hospitalization with intravenous hydrocortisone and intravenous fluids composed of 0.9% sodium chloride.
How to Cope With Addison’s Disease
Living with any chronic disease can be challenging. With Addison’s disease, the greatest challenge may be the avoidance of any illness or event that can trigger an adrenal crisis.
Important strategies include:
While there is no special diet for Addison’s disease, you should avoid low-sodium diets and even increase salt intake if you plan to be in hot weather or engage in strenuous activity. If fatigued, don’t push it—allow your body time to recover.
What Is Adrenal Fatigue?
Summary
Thanks to advances in therapy, people with Addison’s disease can enjoy better health and near-normal life expectancies. Early diagnosis and treatment may further increase these rates. To this end, it is important to see a healthcare provider if you experience recurrent episodes of fatigue, low blood pressure, weight loss, salt craving, or skin color changes that you simply can’t explain. An adrenal crisis doesn’t need to be your first symptom.
If your healthcare provider isn’t familiar with Addison’s disease, ask for a referral to an endocrinologist who can run tests to either confirm or rule out the disease.
A Word From VerywellWhile not very common, Addison’s disease can be serious when it occurs. Hence, prompt identification and management are key to ensuring a good outcome. To manage Addison’s disease and avoid potentially severe complications, regular electrolyte monitoring and timely imbalance corrections are essential.—KASHIF J. PIRACHA, MD, MEDICAL EXPERT BOARD
A Word From Verywell
While not very common, Addison’s disease can be serious when it occurs. Hence, prompt identification and management are key to ensuring a good outcome. To manage Addison’s disease and avoid potentially severe complications, regular electrolyte monitoring and timely imbalance corrections are essential.—KASHIF J. PIRACHA, MD, MEDICAL EXPERT BOARD
While not very common, Addison’s disease can be serious when it occurs. Hence, prompt identification and management are key to ensuring a good outcome. To manage Addison’s disease and avoid potentially severe complications, regular electrolyte monitoring and timely imbalance corrections are essential.
—KASHIF J. PIRACHA, MD, MEDICAL EXPERT BOARD
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Addison disease.Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S.Addison’s disease.Contemp Clin Dent. 2012;3(4):484-486. doi:10.4103/0976-237X.107450National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of adrenal insufficiency & Addison’s disease.Hahner S, Spinnler C, Fassnacht M, et al.High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study.J Clin Endocrinol Metab. 2015;100(2):407-416. doi:10.1210/jc.2014-3191UCLA Health.What is Addison’s disease?Hahner S, Loeffler M, Bleicken B, et al.Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies.Eur J Endocrinol. 2010;162(3):597-602. doi:10.1530/EJE-09-0884Puar TH, Stikkelbroeck NM, Smans LC, Zelissen PM, Hermus AR.Adrenal crisis: still a deadly event in the 21st century.Am J Med. 2016;129(3):339.e1-e9. doi:10.1016/j.amjmed.2015.08.021Michels A, Michels N.Addison disease: early detection and treatment principles.Am Fam Physician. 2014;89(7):563-568.Morin C, Fardet L.Systemic glucocorticoid therapy: risk factors for reported adverse events and beliefs about the drug. A cross-sectional online survey of 820 patients.Clin Rheumatol. 2015;34(12):2119-2126. doi:10.1007/s10067-015-2953-7Daniels J, Sheils E.A complex interplay: cognitive behavioural therapy for severe health anxiety in addison’s disease to reduce emergency department admissions.Behav Cogn Psychother. 2017;45(4):419-426. doi:10.1017/S1352465817000182Oliveira D, Lages A, Paiva S, Carrilho F.Treatment of Addison’s disease during pregnancy.Endocrinol Diabetes Metab Case Rep. 2018;(1). doi:10.1530/EDM-17-0179
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Addison disease.Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S.Addison’s disease.Contemp Clin Dent. 2012;3(4):484-486. doi:10.4103/0976-237X.107450National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of adrenal insufficiency & Addison’s disease.Hahner S, Spinnler C, Fassnacht M, et al.High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study.J Clin Endocrinol Metab. 2015;100(2):407-416. doi:10.1210/jc.2014-3191UCLA Health.What is Addison’s disease?Hahner S, Loeffler M, Bleicken B, et al.Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies.Eur J Endocrinol. 2010;162(3):597-602. doi:10.1530/EJE-09-0884Puar TH, Stikkelbroeck NM, Smans LC, Zelissen PM, Hermus AR.Adrenal crisis: still a deadly event in the 21st century.Am J Med. 2016;129(3):339.e1-e9. doi:10.1016/j.amjmed.2015.08.021Michels A, Michels N.Addison disease: early detection and treatment principles.Am Fam Physician. 2014;89(7):563-568.Morin C, Fardet L.Systemic glucocorticoid therapy: risk factors for reported adverse events and beliefs about the drug. A cross-sectional online survey of 820 patients.Clin Rheumatol. 2015;34(12):2119-2126. doi:10.1007/s10067-015-2953-7Daniels J, Sheils E.A complex interplay: cognitive behavioural therapy for severe health anxiety in addison’s disease to reduce emergency department admissions.Behav Cogn Psychother. 2017;45(4):419-426. doi:10.1017/S1352465817000182Oliveira D, Lages A, Paiva S, Carrilho F.Treatment of Addison’s disease during pregnancy.Endocrinol Diabetes Metab Case Rep. 2018;(1). doi:10.1530/EDM-17-0179
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
MedlinePlus.Addison disease.Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S.Addison’s disease.Contemp Clin Dent. 2012;3(4):484-486. doi:10.4103/0976-237X.107450National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of adrenal insufficiency & Addison’s disease.Hahner S, Spinnler C, Fassnacht M, et al.High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study.J Clin Endocrinol Metab. 2015;100(2):407-416. doi:10.1210/jc.2014-3191UCLA Health.What is Addison’s disease?Hahner S, Loeffler M, Bleicken B, et al.Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies.Eur J Endocrinol. 2010;162(3):597-602. doi:10.1530/EJE-09-0884Puar TH, Stikkelbroeck NM, Smans LC, Zelissen PM, Hermus AR.Adrenal crisis: still a deadly event in the 21st century.Am J Med. 2016;129(3):339.e1-e9. doi:10.1016/j.amjmed.2015.08.021Michels A, Michels N.Addison disease: early detection and treatment principles.Am Fam Physician. 2014;89(7):563-568.Morin C, Fardet L.Systemic glucocorticoid therapy: risk factors for reported adverse events and beliefs about the drug. A cross-sectional online survey of 820 patients.Clin Rheumatol. 2015;34(12):2119-2126. doi:10.1007/s10067-015-2953-7Daniels J, Sheils E.A complex interplay: cognitive behavioural therapy for severe health anxiety in addison’s disease to reduce emergency department admissions.Behav Cogn Psychother. 2017;45(4):419-426. doi:10.1017/S1352465817000182Oliveira D, Lages A, Paiva S, Carrilho F.Treatment of Addison’s disease during pregnancy.Endocrinol Diabetes Metab Case Rep. 2018;(1). doi:10.1530/EDM-17-0179
MedlinePlus.Addison disease.
Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S.Addison’s disease.Contemp Clin Dent. 2012;3(4):484-486. doi:10.4103/0976-237X.107450
National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms and causes of adrenal insufficiency & Addison’s disease.
Hahner S, Spinnler C, Fassnacht M, et al.High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study.J Clin Endocrinol Metab. 2015;100(2):407-416. doi:10.1210/jc.2014-3191
UCLA Health.What is Addison’s disease?
Hahner S, Loeffler M, Bleicken B, et al.Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies.Eur J Endocrinol. 2010;162(3):597-602. doi:10.1530/EJE-09-0884
Puar TH, Stikkelbroeck NM, Smans LC, Zelissen PM, Hermus AR.Adrenal crisis: still a deadly event in the 21st century.Am J Med. 2016;129(3):339.e1-e9. doi:10.1016/j.amjmed.2015.08.021
Michels A, Michels N.Addison disease: early detection and treatment principles.Am Fam Physician. 2014;89(7):563-568.
Morin C, Fardet L.Systemic glucocorticoid therapy: risk factors for reported adverse events and beliefs about the drug. A cross-sectional online survey of 820 patients.Clin Rheumatol. 2015;34(12):2119-2126. doi:10.1007/s10067-015-2953-7
Daniels J, Sheils E.A complex interplay: cognitive behavioural therapy for severe health anxiety in addison’s disease to reduce emergency department admissions.Behav Cogn Psychother. 2017;45(4):419-426. doi:10.1017/S1352465817000182
Oliveira D, Lages A, Paiva S, Carrilho F.Treatment of Addison’s disease during pregnancy.Endocrinol Diabetes Metab Case Rep. 2018;(1). doi:10.1530/EDM-17-0179
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