Addison’s Disease

Addison’s disease is a rare condition where your adrenal glands don’t produce enough of the hormones cortisol and aldosterone.

Cortisol helps your body respond to stress, including the stress of illness, injury or surgery. It also helps maintain your blood pressure and blood glucose (sugar) levels. Aldosterone affects the balance of sodium (salt) and potassium in your blood. This controls the amount of fluid your kidneys remove as urine (pee).

When you don’t have enough of these two hormones, it can affect how your body works. It may lead to symptoms like fatigue, skin changes and loss of appetite.

Addison’s disease is also called primary adrenal insufficiency. A related disorder, secondary adrenal insufficiency, happens when your pituitary gland doesn’t release enough adrenocorticotropic hormone (ACTH). ACTH tells your adrenal glands to produce cortisol.

You can’t prevent Addison’s disease, but medication can help manage your symptoms.

Symptoms of Addison’s disease

Addison’s disease symptoms don’t develop until the disease does serious damage to your adrenal glands. This happens slowly and gradually over time.

Symptoms include:

• Fatigue that worsens over time (most common)
• Patches of dark skin, especially around scars and skin creases and on your gums
• Nausea and vomiting
• Diarrhea
• Loss of appetite and unexplained weight loss
• Muscle pain, muscle spasms and/or joint pain
• Abdominal pain
• Dehydration
• Low blood pressure, which can cause dizziness or blurred vision when standing
• Changes in mood and behavior, such as irritability, depression and poor concentration
• Craving salty food
• Low blood sugar

Women with Addison’s disease may also have irregular periods, lose body hair and have a low sex drive.

Addison’s disease causes

The most common cause of Addison’s disease is damage to your adrenal glands due to an autoimmune response. This is when your immune system attacks healthy tissues. With Addison’s disease, your immune system attacks the outer portion of your adrenal glands (the adrenal cortex). This is where cortisol and aldosterone are made. Symptoms don’t usually develop until most of your adrenal cortex has been damaged. This can take several months or years.

Risk factors

Addison’s disease can affect anyone. But it’s most common in people between ages 30 and 50.

People with a rare, inherited disease called autoimmune polyendocrine syndrome are much more likely to have Addison’s disease.

Your risk of Addison’s disease is also higher if you have any of the following autoimmune diseases:

• Type I diabetes
• Pernicious anemia
• Graves’ disease
• Chronic thyroiditis
• Dermatitis herpetiformis
• Vitiligo
• Myasthenia gravis

Complications of this condition

The main complication of Addison’s disease is Addisonian crisis (or adrenal crisis). Symptoms come on quickly and can be life-threatening.

An Addisonian crisis is a medical emergency. Left untreated, it can lead to shock and death. Symptoms include:

• Extreme weakness
• Sudden, severe pain in your lower back, belly or legs
• Feeling restless, confused, afraid or other mental changes
• Severe vomiting and diarrhea
• Low blood pressure
• Loss of consciousness

Get to the nearest hospital as soon as possible if you’re having these symptoms.

How is Addison’s disease diagnosed?

Because the symptoms of Addison’s disease appear slowly and can look like many other conditions, including other causes of adrenal insufficiency, it may take time to diagnose. A healthcare provider may suspect Addison’s disease if a routine blood test shows low levels of sodium or high levels of potassium. Dark patches on your skin can also be a sign.

If your provider suspects you may have Addison’s disease based on your symptoms, they’ll order more tests to diagnose the condition:

• Blood tests: Your provider will likely order certain tests to measure the levels of sodium, potassium, cortisol and ACTH in your blood.
• ACTH stimulation test: This test measures your adrenal glands’ response after a shot of artificial ACTH. If your adrenal glands make low levels of cortisol after the shot, they may not be working right.
• Insulin-induced hypoglycemia test: Your provider may order this test to see if your symptoms are due to problems with your pituitary gland (secondary adrenal insufficiency) instead of your adrenal glands.
• CT scan: Your provider may order a CT scan to look at your adrenal glands for damage.

How is Addison’s disease treated?

Addison’s disease is treated by replacing cortisol and aldosterone with synthetic versions of them. You’ll need to take medication for the rest of your life to treat primary adrenal insufficiency.

The drug hydrocortisone replaces cortisol. The drug fludrocortisone replaces aldosterone.

The dosages of these medications are different for everyone based on your diagnosis. Your healthcare provider may increase your dosage at certain times to prevent an adrenal crisis.

If you’re taking fludrocortisone, your provider might tell you to increase your salt intake, especially in hot weather and after exercise.

When should I see my healthcare provider?

Contact your healthcare provider if you have symptoms of Addison’s disease, especially if you have an autoimmune condition. They can order tests to see if you have the disease.

What can I expect if I have this condition?

Most people with Addison’s disease can live full, active lives with proper treatment. Managing the disease usually means taking hormone replacement medication and seeing your provider regularly to make sure the dose is working.

Your provider may need to adjust your medication, especially during illness, surgery or times of stress. Taking too much medication can increase your risk of conditions like weight gain, Type 2 diabetes or high blood pressure. Taking too little medication can lead to symptoms returning or increase your risk of an adrenal crisis.

Many people with Addison’s disease also develop another autoimmune condition. Your healthcare provider may monitor you for signs of other autoimmune diseases.

What is the life expectancy of someone with Addison's disease?

With the right treatment, your life expectancy shouldn’t change just because you have Addison’s disease. It’s important to work closely with your healthcare team to make sure your medication is working.