What is Addison’s disease?

Addison’s disease affects your body’s adrenal glands. The adrenal glands are part of the endocrine system. The endocrine system is a group of glands all over your body that produce and secrete hormones to regulate your body’s processes, including your body’s moods, growth, metabolism and tissue function. The adrenal glands are located just above your kidneys. They produce adrenaline-like hormones and a class of hormones called corticosteroids.

What are the symptoms of Addison’s disease?

The symptoms of Addison’s disease usually develop over a period of several months and may include:

• Muscle weakness
• Fatigue
• Weight loss
• Loss of appetite
• Darkening of the skin (called hyperpigmentation)
• Low blood pressure that can sometimes causes fainting
• Cravings for salty foods
• Low blood sugar (called hypoglycemia)
• Nausea
• Diarrhea
• Vomiting
• Irritability
• Sensitivity to cold
• Depression

Sometimes, the symptoms of Addison’s disease appear suddenly. This is called acute adrenal failure or an Addisonian crisis. It can be fatal if it isn't treated. The symptoms may include:

• Pain in the abdomen, lower back or legs
• Severe vomiting and diarrhea
• Dehydration
• Low blood pressure
• Loss of consciousness

What causes Addison’s disease?

Addison’s disease is also called “adrenal insufficiency.” There are 2 types of adrenal insufficiency:

Primary adrenal insufficiency

Primary adrenal insufficiency occurs when the outer layer of the adrenal gland (the part that produces corticosteroids) is damaged and doesn’t produce enough hormones. This damage is usually caused by an autoimmune disease. Normally, your immune system produces antibodies to help protect the body against viruses, bacteria and other foreign substances. An autoimmune disease is when your immune system produces antibodies that attack your body's adrenal glands, or other tissues and/or organs.

Other causes of adrenal gland failure include:

• Tuberculosis
• Other infections of the adrenal glands
• Cancer of the adrenal glands
• Bleeding into the adrenal glands

Secondary adrenal insufficiency

Secondary adrenal insufficiency occurs when you have another condition that causes the adrenal gland to fail to produce enough hormones. For example, secondary insufficiency can be caused by a diseased pituitary gland. The pituitary gland is a gland in your brain that makes a hormone called adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce their hormones. If the pituitary gland is unable to produce enough ACTH, the adrenal glands will not produce enough of their hormones either.

You can also develop temporary secondary adrenal insufficiency if you suddenly stop taking a corticosteroid medicine (such as prednisone). Corticosteroids are prescribed for treatment of conditions such as asthma and arthritis.

How will my doctor know I have Addison’s disease?

Your doctor will ask you about your medical history and your symptoms. He or she may also perform laboratory tests to determine whether you have Addison’s disease:

• Blood tests: Tests that measure the levels of sodium, potassium, cortisol and ACTH in your blood can help your doctor know whether an adrenal insufficiency is causing your symptoms. Your doctor can also use a blood test to see if an autoimmune disease is the possible cause of your Addison’s disease.
• ACTH stimulation test: Your doctor may test your body’s ability to secrete cortisol in response to an injection of synthetic ACTH. This will check to see if your adrenal glands are damaged. In a healthy person, cortisol levels rise after the ACTH injection.
• Insulin-induced hypoglycemia test: If your doctor suspects pituitary gland disease, he or she may test your blood sugar and cortisol levels at various points after an injection of insulin. Normally, glucose levels fall and cortisol levels rise after an insulin injection.
• Imaging tests: Your doctor may want to do a computerized tomography (CT) scan to check the size of your adrenal glands or pituitary gland and look for problems that could help identify the cause of your adrenal insufficiency.

How is Addison’s disease treated?

Treating Addison’s disease usually involves taking prescription corticosteroids to replace the hormones your body is not making. If your body is not making enough cortisol, your doctor may prescribe hydrocortisone, prednisone or cortisone acetate. If your body is not making enough aldosterone, your doctor may prescribe fludrocortisone. These medicines are taken every day by mouth (in pill form).

Your doctor may also recommend you take an androgen replacement called dehydroepiandrosterone. Some women who have Addison’s disease find that taking an androgen replacement improves their mood and sex drive.

If you are experiencing an Addisonian crisis, you need immediate medical care. The treatment typically consists of intravenous (IV) injections of hydrocortisone, saline (salt water) and dextrose (sugar). These injections help restore blood pressure, sugar and potassium levels to normal.

What should I do after my doctor has diagnosed Addison’s disease?

You should prepare yourself to handle a medical emergency if you have Addison’s disease:

• Carry a medical alert card and bracelet at all times so that emergency medical workers know what kind of care you need.
• Keep extra medicine with you in case you forget to take your pills. Ask your doctor about a prescription for an injectable form of corticosteroids for use in emergency situations.
• Keep in touch with your family doctor. Let him or her know if your symptoms change or if your medicines stop working the way they used to.

• Do I have primary or secondary Addison’s disease?
• What is the likely cause of my Addison’s disease?
• What is the best treatment option? Will I need to take medicine? For how long?
• Am I at risk of having an Addisonian crisis?
• Do I need a medical alert bracelet? Do I need emergency medicine?
• Am I at risk for any long-term health problems?