Addison’s disease occurs when your body’s adrenal glands do not produce enough hormones. The adrenal glands are part of your body’s endocrine system, a group of glands that produce and secrete hormones to regulate your body’s processes. The adrenal glands are located just above your kidneys and produce adrenaline-like hormones and a class of hormones called corticosteroids.
Some of the corticosteroid hormones produced by the adrenal glands are essential for life. Glucocorticoids affect your body’s ability to convert food into energy, the immune system’s inflammatory response and your body’s reaction to stress. Mineralocorticoids maintain your body’s balance of sodium, potassium and water.
In Addison’s disease, your adrenal glands do not produce enough cortisol, one of the glucocorticoids. Sometimes, your body also fails to produce enough aldosterone, one of the mineralocorticoids.
Addison’s disease is most common among people ages 30 to 50, but it can occur at any age and affects men and women equally. It is also called adrenal insufficiency or hypocortisolism.
Addison's Disease
Addison's Disease
What is Addison’s disease?
What causes Addison’s disease?
There are 2 types of adrenal insufficiency:
Primary adrenal insufficiency
Primary adrenal insufficiency occurs when the outer layer of the adrenal gland (which produces the corticosteroids) is damaged and doesn’t produce enough hormones. This is usually caused by an autoimmune disease in which the body’s own immune system attacks the adrenal glands. Normally, antibodies produced by the immune system help protect the body against viruses, bacteria and other foreign substances. An autoimmune disease is when your immune system produces antibodies that attack your body's tissues and/or organs.
Other causes of adrenal gland failure are:
Primary adrenal insufficiency
Primary adrenal insufficiency occurs when the outer layer of the adrenal gland (which produces the corticosteroids) is damaged and doesn’t produce enough hormones. This is usually caused by an autoimmune disease in which the body’s own immune system attacks the adrenal glands. Normally, antibodies produced by the immune system help protect the body against viruses, bacteria and other foreign substances. An autoimmune disease is when your immune system produces antibodies that attack your body's tissues and/or organs.
Other causes of adrenal gland failure are:
- Tuberculosis
- Other infections of the adrenal glands
- Cancer of the adrenal glands
- Bleeding into the adrenal glands
Secondary adrenal insufficiency
Secondary adrenal insufficiency occurs when you have another condition that causes the adrenal gland to fail to produce enough hormones. It can be caused by a diseased pituitary gland. The pituitary gland makes a hormone called adrenocorticotropic hormone (ACTH) that stimulates the adrenal glands to produce their hormones. If the pituitary gland is unable to produce enough ACTH, the adrenal glands will not be stimulated to produce their hormones.
You can also develop temporary secondary adrenal insufficiency if you suddenly stop taking a corticosteroid medicine (such as prednisone). Corticosteroids are prescribed for treatment of conditions such as asthma and arthritis.
Secondary adrenal insufficiency occurs when you have another condition that causes the adrenal gland to fail to produce enough hormones. It can be caused by a diseased pituitary gland. The pituitary gland makes a hormone called adrenocorticotropic hormone (ACTH) that stimulates the adrenal glands to produce their hormones. If the pituitary gland is unable to produce enough ACTH, the adrenal glands will not be stimulated to produce their hormones.
You can also develop temporary secondary adrenal insufficiency if you suddenly stop taking a corticosteroid medicine (such as prednisone). Corticosteroids are prescribed for treatment of conditions such as asthma and arthritis.
What are the symptoms of Addison’s disease?
The symptoms of Addison’s disease usually develop over a period of several months and may include:
- Muscle weakness
- Fatigue
- Weight loss
- Loss of appetite
- Darkening of the skin (called hyperpigmentation)
- Low blood pressure, that can sometimes causes fainting
- Cravings for salty foods
- Low blood sugar (called hypoglycemia)
- Nausea
- Diarrhea
- Vomiting
- Irritability
- Sensitivity to cold
- Depression
Sometimes, the symptoms of Addison’s disease appear suddenly. This is called acute adrenal failure or an addisonian crisis. It can be fatal if it isn't treated. The symptoms may include:
- Pain in the abdomen, lower back or legs
- Severe vomiting and diarrhea
- Dehydration
- Low blood pressure
- Loss of consciousness
How will my doctor know I have Addison’s disease?
Your doctor will ask you about your medical history and your symptoms. He or she may also perform laboratory tests to determine whether you have Addison’s disease:
- Blood tests: Tests that measure the levels of sodium, potassium, cortisol and ACTH in your blood can help your doctor know whether an adrenal insufficiency is causing your symptoms. Your doctor can also use a blood test to see if an autoimmune disease is the possible cause of your Addison’s disease.
- ACTH stimulation test: Your doctor may test your body’s ability to secrete cortisol in response to an injection of synthetic ACTH. This will check to see if your adrenal glands are damaged. In a healthy person, cortisol levels rise after the ACTH injection.
- Insulin-induced hypoglycemia test: If your doctor suspects pituitary gland disease, he or she may test your blood sugar and cortisol levels at various points after an injection of insulin. Normally, glucose levels fall and cortisol levels rise after an insulin injection.
- Imaging tests: Your doctor may want to do a computerized tomography (CT) scan to check the size of your adrenal glands or pituitary gland and look for problems that could help identify the cause of your adrenal insufficiency.
How is Addison’s disease treated?
Treating Addison’s disease usually involves taking prescription corticosteroids to replace the hormones your body is not making. If your body is not making enough cortisol, your doctor may prescribe hydrocortisone, prednisone or cortisone acetate. Aldosterone is replaced by fludrocortisone. These medicines are taken every day by mouth (in pill form).
Your doctor may also recommend you take an androgen replacement called dehydroepiandrosterone. Some women who have Addison’s disease find that taking replacement androgen improves their mood and sex drive.
If you are experiencing an addisonian crisis, you need immediate medical care. The treatment typically consists of intravenous (IV) injections of hydrocortisone, saline (salt water) and dextrose (sugar). These injections help restore blood pressure, sugar and potassium levels to normal.
Your doctor may also recommend you take an androgen replacement called dehydroepiandrosterone. Some women who have Addison’s disease find that taking replacement androgen improves their mood and sex drive.
If you are experiencing an addisonian crisis, you need immediate medical care. The treatment typically consists of intravenous (IV) injections of hydrocortisone, saline (salt water) and dextrose (sugar). These injections help restore blood pressure, sugar and potassium levels to normal.
What should I do after my doctor has diagnosed Addison’s disease?
You should prepare yourself to handle a medical emergency if you have Addison’s disease:
- Carry a medical alert card and bracelet at all times so that emergency medical workers know what kind of care you need.
- Keep extra medicine with you in case you forget to take your pills. Ask your doctor about a prescription for an injectable form of corticosteroids for use in emergency situations.
- Keep in touch with your family doctor. Let him or her know if your symptoms change or if your medicines stop working the way they used to.
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Written by familydoctor.org editorial staff.
American Academy of Family Physicians
Reviewed/Updated: 10/09
Created: 09/07