Addison’s Disease

Overview

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 hormones to regulate your body’s processes, including your moods, growth, metabolism, and tissue function. The adrenal glands are located just above your kidneys. They produce hormones that affect how your body responds to stress.

In people who have Addison’s disease, the adrenal glands do not produce enough corticosteroid hormones, such as cortisol and aldosterone.

Addison’s disease is most common among people 30 to 50 years of age, but it can occur at any age and affects men and women equally. It is also called adrenal insufficiency or hypocortisolism.

Symptoms

What are the symptoms of Addison’s disease?

The symptoms of Addison’s disease usually develop over a period of several months. Many of the symptoms of Addison’s disease are nonspecific. This means that at first, it may be hard for you or your doctor to figure out exactly what is wrong. Common symptoms of Addison’s disease may include:

Sometimes, the symptoms of Addison’s disease appear suddenly, or quickly get worse. This is called acute adrenal failure or an Addisonian crisis. It can cause death if it isn’t treated. If you have any of the following symptoms, contact your doctor or go to an emergency room right away:

  • Fatigue
  • Muscle weakness
  • Joint or muscle pain
  • Fever
  • Weight loss
  • Nausea, vomiting and/or diarrhea
  • Headache
  • Sweating
  • Changes in mood or personality, such as irritability, anxiety, or depression
  • Loss of appetite
  • Darkening of the skin (called hyperpigmentation)
  • Lightheadedness or fainting upon standing, most often caused by low blood pressure
  • Cravings for salty foods
  • Sudden, severe pain in the abdomen, lower back, or legs
  • Severe vomiting and diarrhea, leading to dehydration
  • Fainting (loss of consciousness)
  • Low blood pressure
  • Confusion or slurred speech
  • Sluggish movements, or serious muscle weakness
  • Seizures
  • High fever

Causes & Risk Factors

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 adrenal gland is damaged and can’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 one or more of your body’s tissues and/or organs.

Other causes of primary adrenal insufficiency include:

  • Tuberculosis (or 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, a problem with your pituitary gland can cause secondary Addison’s disease. Or, you may develop Addison’s disease if you suddenly stop taking a corticosteroid medicine (such as prednisone). Corticosteroids are sometimes prescribed for treatment of conditions such as asthma, allergies, arthritis, cancer, and immune system problems.

Diagnosis & Tests

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 certain minerals and hormones in your blood can help your doctor figure out whether you have Addison’s disease, and what might be causing it. Your doctor may also want to do special tests to check your blood before and after an injection. These tests help your doctor know whether your body is responding normally to increased levels of certain hormones, such as adrenocorticotrophic hormone (ACTH) and insulin.
  • 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.

Treatment

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 that you take a medicine called dehydroepiandrosterone. Some women who have Addison’s disease find that taking this medicine 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, blood sugar, and potassium levels to normal.

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

If you have Addison’s disease, you need to prepare for the possibility of a medical emergency (Addisonian crisis):

  • 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.

Questions to Ask Your Doctor

  • 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?