Addison’s Disease: Symptoms, Diagnosis, Hormone Replacement, and Adrenal Crisis

Addison’s disease is primary adrenal insufficiency: the adrenal glands do not make enough cortisol and often do not make enough aldosterone. It is different from secondary or tertiary adrenal insufficiency, which result from problems involving the pituitary, hypothalamus or suppression after long-term corticosteroid use.

Common symptoms

Persistent fatigue and muscle weakness
Loss of appetite and unintended weight loss
Abdominal pain, nausea, vomiting or diarrhea
Low blood pressure, dizziness or fainting
Salt craving
Low blood glucose in some people
Darkening of the skin or mucous membranes in primary adrenal insufficiency

What causes Addison’s disease?

In many developed countries, autoimmune destruction of the adrenal cortex is the most common cause. Infections, bleeding, cancer and certain genetic or infiltrative disorders are less common causes.

Diagnosis

Diagnosis uses blood tests, including cortisol and ACTH, and often an ACTH stimulation test. Additional testing may be needed to identify the cause and to assess sodium, potassium and other abnormalities.

Treatment is lifelong hormone replacement

Cortisol is usually replaced with hydrocortisone or another prescribed glucocorticoid. People who also lack aldosterone generally need fludrocortisone. Doses are individualized and must not be changed casually.

Illness, surgery and injury may require “stress dosing”

The body normally produces more cortisol during significant physical stress. People with adrenal insufficiency need a clinician-directed plan for increasing glucocorticoid doses during fever, serious illness, surgery or major injury.

Adrenal crisis is an emergency

Severe vomiting or diarrhea, sudden profound weakness, confusion, loss of consciousness, very low blood pressure or severe abdominal, back or leg pain can signal adrenal crisis. Emergency treatment uses injectable corticosteroid plus intravenous fluids and glucose as needed.

People with known adrenal insufficiency are often advised to carry medical identification and emergency injectable glucocorticoid, with family members taught when and how to use it.

Diet and salt

Some people with primary adrenal insufficiency may need additional sodium, particularly in hot weather or after heavy sweating, but this should be individualized. A generic high-salt diet is not appropriate for everyone.

Editorial sources

This article provides general education and does not replace endocrinology care or an individual emergency steroid plan.