Addison's disease, also called adrenal insufficiency, is an uncommon illness that occurs when the body doesn't make enough of certain hormones. In Addison's disease, the adrenal glands make too little cortisol and, often, too little of another hormone, aldosterone.
Addison's disease can affect anyone and can be life-threatening. Treatment involves taking hormones to replace those that are missing.
Addison's disease symptoms usually happen slowly, often over months. The disease can move so slowly that people who have it may ignore the symptoms at first. Then a stress, such as illness or injury, makes symptoms worse.
Symptoms may include:
Sometimes the symptoms of Addison's disease appear suddenly. Acute adrenal failure can lead to life-threatening shock. Seek emergency treatment for the following:
See a health care provider if you have common symptoms of Addison's disease, such as:
Addison's disease is caused by damage to the adrenal glands. The adrenal glands sit just above the kidneys. As part of the endocrine system, they make hormones that affect almost every organ and tissue in the body. Damage to these glands results in too little of the hormone cortisol and, often, the hormone aldosterone.
The adrenal glands are made up of two sections. The interior, called the medulla, makes adrenaline-like hormones. The outer layer, called the cortex, makes a group of hormones called corticosteroids. Corticosteroids include:
Sometimes, the outer layer of the adrenal glands, known as the cortex, is damaged. Then it can't make enough hormones, a condition called primary adrenal insufficiency. This is usually the result of an autoimmune disease, in which the body attacks itself. People with Addison's disease are more likely than are other people to have another autoimmune disease as well.
Other causes of adrenal gland failure may include:
The pituitary gland makes a hormone called adrenocorticotropic hormone (ACTH). ACTH in turn causes the adrenal cortex to make its hormones. Having pituitary tumors that aren't cancer, inflammation and pituitary surgery can cause the pituitary gland to make too little ACTH.
Too little ACTH can cause the adrenal glands to make too little glucocorticoids and androgens. This is called secondary adrenal insufficiency.
Most symptoms of secondary adrenal insufficiency are similar to those of primary adrenal insufficiency. However, people with secondary adrenal insufficiency don't have darkened skin and are less likely to have severe dehydration or low blood pressure. They're more likely to have low blood sugar.
A temporary cause of secondary adrenal insufficiency occurs when people who take corticosteroids, such as prednisone, to treat conditions such as asthma or arthritis, stop taking the medicine suddenly rather than tapering off.
Most people who get Addison's disease don't have any factors that put them at higher risk of developing the condition. But the following may raise the risk of developing Addison's disease:
Addisonian crisis. If you have untreated Addison's disease, you may develop an addisonian crisis as a result of stress on the body, such as injury, infection or illness. Typically, the adrenal glands make two or three times the usual amount of cortisol in response to physical stress. With adrenal insufficiency, not being able to increase the amount of cortisol made as a result of stress can lead to an addisonian crisis.
An addisonian crisis is a life-threatening situation that results in low blood pressure, low blood levels of sugar and high blood levels of potassium. It requires immediate medical care.
Addison's disease can't be prevented, but there are ways to avoid an addisonian crisis:
Some people with Addison's disease worry about serious side effects from hydrocortisone or prednisone. However, people with Addison's disease aren't as likely to get the side effects of high-dose glucocorticoids. That's because the dose prescribed replaces the amount that's missing.
If you take cortisone, be sure to follow up with your provider regularly to make sure your dose is not too high.
Your health care provider will talk to you about your medical history and your symptoms. You might have some of the following tests:
Medicines are used to treat Addison's disease. Hormone replacement therapy corrects the levels of steroid hormones the body isn't making enough of. Some treatments include oral corticosteroids such as:
You likely need plenty of salt in your diet. This is especially true during heavy exercise, when the weather is hot or if you have digestive upsets, such as diarrhea.
Your health care provider may increase your medicine for a short time if your body is stressed. Such stress can come from having surgery, an infection or a minor illness. If you're vomiting and can't keep down your medicine, you may need shots of corticosteroids.
Other treatment recommendations include:
An addisonian crisis is a medical emergency. Treatment typically includes IV:
Researchers are working to develop delayed-release corticosteroids, which act more like the hormones made by the human body. They also are studying the use of pumps placed under the skin that can deliver steroids in more-accurate doses.
You're likely to start by seeing your primary care provider. However, you might be referred to an endocrinologist, a doctor who treats conditions of the endocrine glands.
Here's information to help you get ready for your appointment.
Take a family member or friend with you to help you remember the information you get.
Make a list of:
For Addison's disease, questions might include:
Don't hesitate to ask other questions as well.
Your provider may ask:
