Addison’s disease, also known as primary adrenal insufficiency, is a rare but serious condition that occurs when the adrenal glands fail to produce enough of the vital hormones cortisol and aldosterone. These hormones are essential to maintaining critical bodily functions such as blood pressure regulation, immune response, electrolyte balance, and energy metabolism.

Although Addison’s disease can affect people of all ages and genders, it is more common in women between the ages of 30 and 50. While this condition is chronic and requires lifelong management, people with Addison’s disease can live healthy lives with proper diagnosis and consistent treatment.

What Is Addison’s Disease?

The adrenal glands are two small organs located above each kidney. They are responsible for producing various hormones. In Addison’s disease, the outer layer of the adrenal glands (the cortex) becomes damaged, leading to a deficiency in two key hormones:

  • Cortisol: Often referred to as the “stress hormone,” cortisol plays a crucial role in controlling metabolism, blood pressure, immune responses, and inflammation.
  • Aldosterone: Helps maintain the balance of sodium and potassium in the body, regulates blood volume and pressure, and supports proper heart function.

When the body does not receive enough of these hormones, various essential processes become impaired, resulting in a range of symptoms.

Signs and Symptoms of Addison’s Disease

Symptoms of Addison’s disease often appear gradually and may be mistaken for other illnesses, which can delay diagnosis. However, if left untreated, the condition may progress and become life-threatening.

Common symptoms include:

  • Persistent fatigue
  • Unexplained weight loss
  • Loss of appetite
  • Craving for salty foods
  • Muscle weakness or pain
  • Low blood pressure
  • Dizziness or fainting when standing up
  • Digestive issues such as nausea, abdominal pain, or diarrhea
  • Mood changes like irritability or depression
  • Irregular menstrual cycles (in women)
  • Reduced libido
  • Skin hyperpigmentation, especially around scars, skin folds, and mucous membranes like the gums

Addisonian Crisis: An Emergency Condition

In some cases, symptoms may appear suddenly and severely—this is known as an Addisonian crisis. It is a medical emergency that requires immediate treatment and is usually triggered by severe infections, physical trauma, or surgery.

Symptoms of a crisis include:

  • Sharp pain in the abdomen, back, or legs
  • Sudden drop in blood pressure
  • Severe dehydration
  • Vomiting and diarrhea
  • Confusion or unconsciousness
  • Risk of kidney failure if left untreated

What Causes Addison’s Disease?

The most common cause of Addison’s disease is autoimmune adrenalitis, where the immune system mistakenly attacks and damages the adrenal glands. This autoimmune destruction leads to a loss of hormone production.

Other potential causes include:

  • Infections such as tuberculosis, HIV, or meningitis
  • Cancers like lymphoma or sarcoidosis
  • Adrenal hemorrhage or trauma
  • Genetic disorders affecting adrenal gland function
  • Surgical removal of the adrenal glands
  • Medications such as ketoconazole (an antifungal) or etomidate (an anesthetic)

Who’s at Risk?

Anyone can develop Addison’s disease, but some people are more likely to be affected, including:

  • Women between the ages of 30 and 50
  • People with a family history of autoimmune disorders
  • Individuals who have other autoimmune diseases, such as:
    • Type 1 diabetes
    • Graves’ disease (hyperthyroidism)
    • Hashimoto’s thyroiditis (hypothyroidism)
    • Vitiligo

How Is Addison’s Disease Diagnosed?

Diagnosis typically begins with a review of symptoms and blood tests. Electrolyte imbalances—such as low sodium and high potassium—can raise suspicion.

Key diagnostic tests include:

  • Serum cortisol test: A cortisol level below 3 mcg/dL strongly suggests adrenal insufficiency.
  • ACTH stimulation test: Measures the adrenal gland’s response to synthetic ACTH; a poor response indicates Addison’s disease.
  • DHEAS level: Often reduced in adrenal insufficiency.
  • Imaging: A CT scan of the abdomen can help evaluate adrenal gland size and detect abnormalities.

How Is Addison’s Disease Treated?

Addison’s disease is treated through lifelong hormone replacement therapy to restore cortisol and aldosterone levels.

Common medications include:

  • Hydrocortisone or prednisolone: Replaces cortisol. Usually taken 2–3 times daily.
  • Fludrocortisone acetate: Replaces aldosterone to help maintain electrolyte balance and blood pressure.

Dosages may need to be adjusted during times of physical stress, including:

  • Fever or illness
  • Surgery
  • Injury or trauma
  • Pregnancy

Emergency Treatment for Addisonian Crisis:

  • Intravenous (IV) hydrocortisone
  • IV fluids and electrolyte replacement
  • Close monitoring of blood pressure and kidney function

Preventing Complications and Managing Long-Term

Although Addison’s disease cannot be prevented, complications can be avoided through early diagnosis and consistent treatment.

Long-term management tips:

  • Take medication exactly as prescribed
  • Wear a medical alert bracelet indicating adrenal insufficiency and steroid dependence
  • Keep an emergency hydrocortisone injection kit for urgent use
  • Follow up regularly with your healthcare provider to adjust dosages
  • Maintain a balanced diet with sufficient calcium and vitamin D to prevent bone loss from steroid use

Potential Complications

If left untreated or improperly managed, Addison’s disease can lead to:

  • Severe fatigue and weakness
  • Chronic low blood pressure
  • Electrolyte imbalances
  • Addisonian crisis (life-threatening)
  • Skin darkening (hyperpigmentation)
  • Osteoporosis or high blood sugar from overuse of corticosteroids

Additionally, up to 50% of people with Addison’s disease may develop another autoimmune disorder over time.

Living Well with Addison’s Disease

With proper treatment and lifestyle adjustments, people with Addison’s disease can live full, active lives. Education about the condition, adherence to medication, and preparation for emergencies are the keys to long-term success.

If you experience persistent fatigue, unexplained weight loss, or other unusual symptoms, speak with your healthcare provider. Early detection and treatment can greatly reduce the risk of complications and improve your quality of life.