Addison's Disease: What It Is, Causes, Symptoms & Treatment (2022)

Overview

What is Addison's disease?

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

Your adrenal glands, also known as suprarenal glands, are small, triangle-shaped glands that are located on top of each of your two kidneys. They’re a part of your endocrine system.

Cortisol is a hormone that helps your body respond to stress, including the stress of illness, injury or surgery. It also helps maintain your blood pressure, heart function, immune system and blood glucose (sugar) levels. Cortisol is essential for life.

Aldosterone is a hormone that affects the balance of sodium (salt) and potassium in your blood. This in turn controls the amount of fluid your kidneys remove as urine (pee), which affects blood volume and blood pressure.

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), which activates your adrenal glands to produce cortisol.

What’s the difference between Addison's disease and Cushing's syndrome?

Addison’s disease happens when your body doesn’t have enough cortisol (and aldosterone), whereas Cushing’s syndrome happens when your body has too much cortisol (hypercortisolism).

Who does Addison’s disease affect?

Addison’s disease can affect people of all age groups, but it’s most common in people 30 to 50 years old.

People who have autoimmune polyendocrine syndrome, a rare, inherited condition in which your immune system mistakenly attacks many of your tissues and organs, are much more likely to have Addison’s disease. Your mucous membranes, adrenal glands and parathyroid glands are commonly affected by this syndrome, though it can affect other types of tissues and organs.

(Video) Addison's Disease, Causes, Signs and Symptoms, Diagnosis and Treatment.

People who have the following autoimmune disease are also at higher risk of developing the autoimmune (most common) form of Addison's disease:

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

How common is Addison’s disease?

Addison’s disease is rare. In the United States, it affects 1 in 100,000 people.

Symptoms and Causes

What are the symptoms of Addison’s disease?

With Addison’s disease, the damage to your adrenal glands usually happens slowly over time, so symptoms occur gradually. Symptoms vary from person to person.

Symptoms of Addison’s disease include:

  • Steadily worsening fatigue (most common symptom).
  • Patches of dark skin (hyperpigmentation), especially around scars and skin creases and on your gums.
  • Abdominal pain.
  • Nausea and vomiting.
  • Diarrhea.
  • Loss of appetite and unintentional weight loss.
  • Muscle pain, muscle spasms and/or joint pain.
  • Dehydration.
  • Low blood pressure, which can cause lightheadedness or dizziness upon standing.
  • Changes in mood and behavior, such as irritability, depression and poor concentration.
  • A craving for salty food.
  • Low blood sugar (hypoglycemia).

People assigned female at birth with Addison’s disease may also have abnormal menstruation (periods), lose body hair and have a decreased sexual drive.

In some cases — such as after an injury or severe illness or time of intense stress — symptoms can come on quickly and cause a life-threatening event called an addisonian crisis or acute adrenal failure.

An addisonian crisis is a medical emergency. If it’s not treated, it can lead to shock and death. Symptoms of an addisonian crisis 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, potentially leading to dehydration.
  • Low blood pressure.
  • Loss of consciousness.

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

(Video) Addison Disease - Causes, Symptoms, Treatments & More…

What causes Addison’s disease?

The most common cause of Addison’s disease is an autoimmune response, which occurs when your immune system attacks healthy tissues for an unknown reason. With Addison’s disease, your immune system attacks the outer portion of your adrenal glands (the adrenal cortex), where they make cortisol and aldosterone. Symptoms don’t usually develop until 90% of the adrenal cortex has been damaged, which can take several months to years.

Approximately 75% of cases of Addison’s disease are due to an autoimmune attack. Autoimmune Addison’s disease may happen by itself or as part of a rare, inherited syndrome, specifically autoimmune polyendocrine syndromes I (APS type-1) and II (Schmidt syndrome).

In the past, tuberculosis was a major cause of Addison’s disease. It remains a prominent cause of the condition in developing countries.

Other less common causes of Addison’s disease include:

  • Repeated infections, including HIV/AIDS-related infections and fungal infections.
  • When cancer cells from another part of your body invade your adrenal glands.
  • Bleeding (hemorrhaging) into your adrenal glands.
  • Surgical removal of your adrenal glands.
  • Amyloidosis (a condition in which amyloid proteins build up in vital organs, causing damage).

Diagnosis and Tests

How is Addison’s disease diagnosed?

Since symptoms of Addison’s disease usually develop slowly over time and are usually vague and common to many different conditions, it often leads to a delay in the proper diagnosis.

Healthcare providers often “accidentally” discover Addison’s disease when a routine blood test, such as a basic metabolic panel, shows low levels of sodium or high levels of potassium.

Dark patches on your skin are another common symptom that signals healthcare providers to test for Addison’s disease.

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

(Video) Primary adrenal insufficiency (Addison's disease) - pathology, symptoms, diagnosis, treatment

What tests will be done to diagnose Addison’s disease?

To determine if you have Addison’s disease, your healthcare provider may order the following tests:

  • 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 you’re given a shot of artificial ACTH. If your adrenal glands produce low levels of cortisol after the shot, they may not be functioning properly.
  • Insulin-induced hypoglycemia test: Your provider may order this test to determine if your symptoms are due to problems with your pituitary gland (secondary adrenal insufficiency) instead of your adrenal glands. This test measures blood sugar (glucose) levels before and after the injection of fast-acting insulin, which should lead to a drop in blood sugar (hypoglycemia) and a rise in cortisol.
  • Computed tomography (CT scan): Computed tomography is an imaging test that uses computers to combine many X-ray images into cross-sectional views. Your provider may order a CT scan to evaluate your adrenal glands and/or pituitary gland. For example, it can show if your immune system has damaged your adrenal glands or if the glands are infected.

Management and Treatment

How is Addison’s disease treated?

Addison’s disease is treated by replacing the missing hormones, cortisol and aldosterone, with synthetic versions of them.

Cortisol is replaced by the drug hydrocortisone, and aldosterone is replaced by the drug fludrocortisone. Addison’s disease is a chronic condition, so you’ll need to take medication for the rest of your life.

The dosages of these medications are different for each person, and your healthcare provider may increase the dosage when you’re experiencing an infection, trauma, surgery and other stressful situations to prevent an acute adrenal crisis.

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

Prevention

Can Addison’s disease be prevented?

Unfortunately, there’s nothing you can do to prevent Addison’s disease.

Outlook / Prognosis

What is the prognosis (outlook) for Addison’s disease?

The prognosis for Addison’s disease is generally good. Although people who have Addison’s disease will need to take medicine for the rest of their lives, they can live normal, healthy lives.

The dosages of these medications, however, need to be closely monitored to prevent over- or under-treatment. Over-treatment with glucocorticoids (hydrocortisone) may result in obesity, Type 2 diabetes and osteoporosis. Over-treatment with fludrocortisone can cause high blood pressure (hypertension).

Up to 50% of people with Addison’s disease develop another autoimmune condition.

(Video) Doctor explains Addison's disease (Adrenal insufficiency): definition, symptoms, treatment & more.

Living With

How do I take care of myself if I have Addison’s disease?

If you have Addison’s disease, you should carry an identification card and wear a medical alert bracelet or necklace at all times to let medical professionals know you have the condition in emergencies.

Talk to your healthcare provider about what you should do when you become sick or are experiencing intense stress since you’ll likely need to increase your medication dosages.

Ask your provider about keeping a shot of cortisol for emergencies, and be sure someone with you knows how to give you the shot.

When should I see my healthcare provider about Addison’s disease?

If you have Addison’s disease, you’ll need to see your healthcare provider (likely an endocrinologist) regularly to make sure your medication dosages are working for you.

Call your provider if you have major stress — such as an injury, illness or the death of a loved one — because you might need an adjustment to your medicine.

(Video) Addison's Disease and Conn Syndrome - Causes, Symptoms, and Treatment

Seek medical attention right away if you have any of the symptoms of an addisonian crisis, such as sudden, extreme weakness and intense pain.

A note from Cleveland Clinic

Receiving a diagnosis of a chronic condition can be overwhelming and stressful. The good news is that Addison’s disease is treatable with medication. It’s important to see your healthcare provider regularly to make sure your dosages are correct and to prevent an episode of acute adrenal failure. If you have any questions about managing Addison’s disease, talk to your provider. They’re always available to help you.

FAQs

What are the cause and treatment of Addison's disease? ›

Addison's disease is a rare chronic condition in which your adrenal glands don't produce enough of the hormones cortisol and aldosterone. It's most often caused by an autoimmune attack. It's treatable with medication.

What is the main cause of Addison's disease? ›

Addison's disease is caused by damage to your adrenal glands, resulting in not enough of the hormone cortisol and, often, not enough aldosterone as well.

What is the best treatment for Addison disease? ›

Medicine for Addison's disease

A medicine called hydrocortisone is usually used to replace the cortisol. Other possible medicines are prednisolone or dexamethasone, although these are less commonly used. Aldosterone is replaced with a medicine called fludrocortisone.

What problems does Addison's disease cause? ›

The most common symptoms are fatigue, muscle weakness, loss of appetite, weight loss, and abdominal pain. Adrenal insufficiency can be caused by autoimmune disease or suddenly stopping steroid medicines used to treat other conditions, among other causes.

What were your first symptoms of Addison's disease? ›

Initial symptoms of Addison's disease can include:
  • fatigue (lack of energy or motivation)
  • lethargy (abnormal drowsiness or tiredness)
  • muscle weakness.
  • low mood (mild depression) or irritability.
  • loss of appetite and unintentional weight loss.
  • the need to urinate frequently.
  • increased thirst.
  • craving for salty foods.
Nov 1, 2021

Who is at risk for Addison's disease? ›

Women are more likely than men to develop Addison's disease. This condition occurs most often in people between the ages of 30 and 50, 2 although it can occur at any age, even in children. Secondary adrenal insufficiency occurs in people with certain conditions that affect the pituitary.

Does Addison's disease affect the brain? ›

Regardless of the specific terminology used, it is clear that some patients with Addison's disease have a disturbance in brain function and may develop a range of neuropsychiatric symptoms as a result.

What is the test for Addison's disease? ›

Blood test.

Tests can measure your blood levels of sodium, potassium, cortisol and adrenocorticotropic hormone (ACTH), which stimulates the adrenal cortex to produce its hormones. A blood test can also measure antibodies associated with autoimmune Addison's disease.

What are the long term effects of Addison's disease? ›

Long-lasting fatigue is a common symptom of adrenal insufficiency. People with Addison's disease may also have darkening of their skin. This darkening is most visible on scars; skin folds; pressure points such as the elbows, knees, knuckles, and toes; lips; and mucous membranes such as the lining of the cheek.

Can Addison's disease disappear? ›

Addison's disease cannot be cured but can be significantly improved with hormone replacement therapy and the avoidance of common triggers. If treated properly, Addison's disease can be brought under control and you can be better assured of living a long and healthy life.

What treatments are available for Addison's disease? ›

What medications are available for Addison's disease?
  • Hydrocortisone – these tablets replace the missing cortisol. ...
  • Fludrocortisone – might be prescribed for missing aldosterone.
  • Dehydroepiandrosterone (DHEA) – these pills may be prescribed if there is an androgen (the male sex hormone) deficiency.

How long can you live with Addison's disease? ›

With the right balance of daily medication, people with Addison's can expect to have a normal life span. It is not unknown for people with Addison's to live into their 90s.

Is Addisons disease genetic? ›

The cause of autoimmune Addison disease is complex and not completely understood. A combination of environmental and genetic factors plays a role in the disorder, and changes in multiple genes are thought to affect the risk of developing the condition.

What are 3 diseases that affect the adrenal glands? ›

Some of the most common include:
  • Addison's disease, also called adrenal insufficiency. In this disorder, you don't produce enough cortisol and/or aldosterone.
  • Cushing's syndrome. ...
  • Congenital adrenal hyperplasia. ...
  • Adrenal gland suppression. ...
  • Hyperaldosteronism. ...
  • Virilization.
Jun 7, 2021

Can Addison's disease be cured? ›

Addison's disease cannot be cured, but replacement hormones can treat the adrenal failure symptoms. Addison's disease (primary adrenal insufficiency) is a condition that occurs when the body's adrenal glands do not work normally.

Does Addison's disease cause pain? ›

During an addisonian crisis, affected individuals may develop a sudden loss of strength; severe pain in the lower back, abdomen or legs; vomiting and diarrhea potentially causing dehydration; and low blood pressure and loss of consciousness.

Can Covid cause Addison's disease? ›

He was diagnosed as suffering from adrenal insufficiency and started on steroids with subsequent improvement in both blood pressure and sodium level. COVID-19 can cause adrenal insufficiency. Clinicians must be vigilant about the possibility of an underlying relative cortisol deficiency in patients with COVID-19.

Does Addison's cause weight gain? ›

One of the most common signs of this disorder is the feeling of fatigue and sluggishness. However, it is common that people with this disorder experience weight gain, while patients with Addison's disease will lose weight due to the vomiting and anorexia.

Does Addison's disease affect sleep? ›

Patients with Addison's disease (AD) experience consistent and predictable periods of sub- and supra-physiological cortisol concentrations due to lifelong glucocorticoid replacement therapy, and they frequently report disrupted sleep and impaired memory.

What is the death rate of Addison's disease? ›

Altogether, Addison's disease was verified in 811 patients; between 6 and 24 new patients were diagnosed per year over the last 20 years, yielding incidence rates 2.0–6.5 per million per year. One hundred and forty-seven (81 women, 66 men) of the patients had died in the period 1966–2005.

Can Addison's disease cause paralysis? ›

Hyperkalemic paralysis due to Addison's disease is rare, and potentially life-threatening entity presenting with flaccid motor weakness. This case under discussion highlights Hyperkalemic paralysis as initial symptomatic manifestation of primary adrenal insufficiency.

Does Addisons disease affect eyesight? ›

Virtually all patients have visual symptoms. Loss of acuity, hemianopia, visual agnosia, optic atrophy, and strabismus are the most common features. Neuropathy may cause a decrease in corneal sensation. Gaze abnormalities due to ocular apraxia are sometimes seen.

How long is Addison's diagnosed? ›

Further blood samples will be taken to measure cortisol after 30 minutes and after 60 minutes. If the ACTH level is high but the cortisol and aldosterone levels are low, it's usually confirmation of Addison's disease.

Can stress make Addison's disease worse? ›

When you don't have a normal amount of adrenal hormones, stress can overwhelm your body and lead to an Addisonian crisis. An Addisonian crisis may be triggered by certain traumatic events, including: a car accident.

Can Addisons be treated naturally? ›

Addison's disease treatment involves taking hormones to replace those that are not being produced by the adrenal glands. Other natural remedies for Addison's disease include consuming enough salt, managing stress, eating a supportive diet and taking supplements like adaptogens and certain vitamins.

What fungal infections cause Addison's disease? ›

The infections attributed to cause Addison's include disseminated gonococcal infection, tuberculosis, histoplasmosis, cryptococcosis and cytomegalovirus (CMV) infection.

Can Addison's disease affect the heart? ›

Although cardiovascular manifestations of Addison's disease include hypotension, syncope, and arrhythmias, the development of a dilated cardiomyopathy and heart failure are an uncommon life-threatening complication [4–8].

Where is adrenal gland pain located? ›

The most common symptom reported by patients with adrenocortical cancer is pain in the back or side (called the flank). Unfortunately, this type of pain is common and does not directly suggest a disease of the adrenal cortex.

What doctor treats adrenal gland problems? ›

If you have adrenal insufficiency, your provider will refer you to an endocrinologist — a hormone specialist.

What is the most common cause of adrenal insufficiency? ›

Primary adrenal insufficiency is most often caused when your immune system attacks your healthy adrenal glands by mistake. Other causes may include: Cancer. Fungal infections.

What is the most common cause of adrenal insufficiency? ›

Primary adrenal insufficiency is most often caused when your immune system attacks your healthy adrenal glands by mistake. Other causes may include: Cancer. Fungal infections.

What is the treatment for low cortisol levels? ›

Cortisol is replaced with a corticosteroid, most often hydrocortisone link, which you take two or three times a day by mouth. Less often, doctors prescribe prednisone link or dexamethasone link.

What are 3 diseases that affect the adrenal glands? ›

Some of the most common include:
  • Addison's disease, also called adrenal insufficiency. In this disorder, you don't produce enough cortisol and/or aldosterone.
  • Cushing's syndrome. ...
  • Congenital adrenal hyperplasia. ...
  • Adrenal gland suppression. ...
  • Hyperaldosteronism. ...
  • Virilization.
Jun 7, 2021

What is Addison's disease Class 11? ›

Addison's disease is caused by under secretion of ACTH (Adrenocorticotropic hormone). It is produced by the pituitary glands. It stimulates the adrenal glands to produce the hormone cortisol. Cortisol stimulates gluconeogenesis and maintains blood pressure.

What fungal infections cause Addison's disease? ›

The infections attributed to cause Addison's include disseminated gonococcal infection, tuberculosis, histoplasmosis, cryptococcosis and cytomegalovirus (CMV) infection.

Can Addison's disease be cured? ›

Addison's disease cannot be cured, but replacement hormones can treat the adrenal failure symptoms. Addison's disease (primary adrenal insufficiency) is a condition that occurs when the body's adrenal glands do not work normally.

What are the long term effects of Addison's disease? ›

Long-lasting fatigue is a common symptom of adrenal insufficiency. People with Addison's disease may also have darkening of their skin. This darkening is most visible on scars; skin folds; pressure points such as the elbows, knees, knuckles, and toes; lips; and mucous membranes such as the lining of the cheek.

What tests confirm Addison's disease? ›

Diagnosis
  • Blood test. Tests can measure your blood levels of sodium, potassium, cortisol and adrenocorticotropic hormone (ACTH), which stimulates the adrenal cortex to produce its hormones. ...
  • ACTH stimulation test. ACTH signals your adrenal glands to produce cortisol. ...
  • Insulin-induced hypoglycemia test. ...
  • Imaging tests.
Nov 24, 2020

Are there any new treatments for Addison's disease? ›

Recent findings: Conventional steroid replacement for Addison's disease consists of twice or three-times daily oral hydrocortisone and once-daily fludrocortisone; however, new treatment modalities such as modified-released hydrocortisone and continuous subcutaneous hydrocortisone infusion have recently been developed.

Videos

1. Addison's Disease - Overview (clinical features, pathophysiology, investigations, treatment)
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5. Addison’s disease :: Causes, Symptoms, Diagnosis, Treatment, Complications,
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