Addison's Disease
Addison's disease, also known as primary adrenal insufficiency, is a rare condition in which the adrenal glands do not produce enough cortisol and, often, aldosterone. These hormones are essential for stress response, blood pressure regulation, metabolism, and electrolyte balance. Addison's disease can be life-threatening if untreated, particularly during physiological stress, when an adrenal crisis (acute adrenal insufficiency) can develop rapidly.
Symptoms
Causes
- Autoimmune destruction of the adrenal cortex (most common cause in developed countries, ~70-90%)
- Tuberculosis or other infections affecting the adrenal glands
- Adrenal hemorrhage or infarction
- Cancer metastasis to the adrenal glands
- Genetic conditions such as adrenoleukodystrophy or congenital adrenal hyperplasia
Risk Factors
- Other autoimmune conditions (type 1 diabetes, thyroid disease, vitiligo)
- Family history of autoimmune diseases
- Female sex (autoimmune Addison's is more common in women)
- Age 30-50 at onset (for autoimmune form)
- HIV/AIDS or tuberculosis infection
Diagnosis
- Morning serum cortisol level (low in Addison's disease)
- ACTH stimulation test (definitive test—cortisol fails to rise appropriately after synthetic ACTH)
- Serum ACTH level (elevated in primary adrenal insufficiency)
- Serum electrolytes (low sodium, high potassium) and blood glucose
- Adrenal autoantibodies (21-hydroxylase antibodies) for autoimmune confirmation
- CT or MRI of the adrenal glands to assess size and detect calcification, hemorrhage, or infiltration
Treatment
- Lifelong hormone replacement with oral hydrocortisone (cortisol replacement) taken 2-3 times daily
- Fludrocortisone (aldosterone replacement) for mineralocorticoid deficiency
- Stress dosing: doubling or tripling hydrocortisone during illness, injury, or surgery
- Injectable emergency hydrocortisone kit for adrenal crisis
- Medical alert identification (bracelet/card) indicating adrenal insufficiency
- Regular endocrinology follow-up to monitor and adjust medication doses
Prevention
- No prevention for the autoimmune form, but early diagnosis and treatment prevent complications
- Patients on chronic corticosteroids should taper slowly under medical supervision to prevent secondary adrenal insufficiency
- Stress dosing education to prevent adrenal crisis during illness
- Carry an emergency injection kit and medical alert identification at all times
When to See a Doctor
- You experience persistent fatigue, weight loss, and darkening skin without explanation
- You have known Addison's disease and become ill with vomiting, fever, or inability to take medications
- You experience sudden severe weakness, confusion, or loss of consciousness (adrenal crisis is a medical emergency)
Frequently Asked Questions
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