Addison’s Disease 101

Addison’s disease, also called primary adrenal insufficiency, is a chronic condition where the adrenal glands don't produce enough hormones — mainly cortisol and aldosterone.

Severely low levels of cortisol and aldosterone can cause life-threatening complications, including sudden drops in blood pressure and organ failure.

Addison’s disease is caused by damage to the outer layer of the adrenal glands, which is responsible for hormone production.

For most people, the damage is caused by the immune system mistakenly attacking the adrenal glands, which means it’s an autoimmune condition.

But damage to the adrenal glands can also be caused by:

• Infections such as fungal infections, HIV or tuberculosis
• A hemorrhage into the adrenal glands
• Tumors

Symptoms of Addison’s disease usually develop slowly over time and can be non-specific, which can make getting a proper diagnosis more difficult.

Symptoms of Addison’s disease can include:

• Dehydration
• Extreme fatigue
• Diarrhea
• Nausea and vomiting
• Abdominal pain
• Low blood pressure
• Low-grade fever
• Weight loss
• Muscle weakness
• Darker skin on the inside of lips, cheeks or gums
• Low blood sugar
• Fainting or dizziness when standing
• Salt cravings
• Joint pain
• Irregular periods or no periods

Symptoms may come and go, and many people with Addison’s disease often don’t know they have the condition until a stressor, such as an illness or infection, triggers symptoms.

A severe lack of cortisol can cause sudden, life-threatening complications, including very low blood pressure and heart problems, which is called adrenal crisis. Adrenal crisis is a medical emergency and should be treated immediately. People with Addison’s disease should carry a medical ID bracelet with the type of medication and dosage needed during an adrenal crisis.

Most adults diagnosed with Addison’s disease are between the ages of 30 and 50 — and the disease is more common in women.

Having certain other autoimmune diseases also increase the risk for Addison’s disease. These can include:

• Chronic thyroiditis
• Dermatis herpetiformis
• Graves' disease
• Hypoparathyroidism
• Hypopituitarism
• Pernicious anemia
• Myasthenia gravis
• Type 1 diabetes
• Vitiligo

There are different tests and imaging that can help your healthcare provider (HCP) diagnose Addison’s disease.

• Blood tests to check levels of sodium, potassium, cortisol, white blood cells, testosterone and estrogen

• ACTH stimulation blood test to measure how the adrenal glands respond to adrenocorticotropic hormone (ACTH) — the hormone that stimulates the release of cortisol

• A CT scan to check the size of the adrenal glands

• An X-ray of the abdomen

Treatment for Addison’s disease usually includes two medications to control symptoms:

• Corticosteroids — synthetic drugs that mimic cortisol
• Mineralocorticoids — synthetic versions of aldosterone

Your HCP may increase the dosage of these medications to help prevent adrenal crisis during stress like surgery or if you have an infection.

Hydrocortisone injections are also prescribed as emergency medications for adrenal crisis.