Addison's disease, medically referred to as primary adrenal insufficiency, is a rare but serious condition where the adrenal glands fail to produce enough cortisol and, in some cases, aldosterone. These hormones are essential for maintaining blood pressure, metabolism, stress response, and electrolyte balance. When production is impaired, a range of symptoms may appear, from fatigue to life-threatening crises.

While the disease affects a small percentage of the population—approximately 1 in 100,000 in the U.S.—its impact can be significant. Early diagnosis and consistent treatment are crucial to managing this lifelong condition effectively.

Common Symptoms

Symptoms of Addison's disease can develop slowly over months or even years, making diagnosis a challenge. However, there are common signs that may prompt a healthcare provider to investigate further:

  • Persistent fatigue and weakness

  • Loss of appetite and unintentional weight loss

  • Nausea, vomiting, and abdominal discomfort

  • Hyperpigmentation (darkened patches of skin, especially on scars, skin folds, and gums)

  • Low blood pressure, especially noticeable when standing (orthostatic hypotension)

  • Salt cravings

  • Mood changes, including depression and irritability

  • Low blood sugar (hypoglycemia)

  • Dizziness or fainting

  • Muscle or joint pain

  • Menstrual irregularities in women

These symptoms tend to worsen during physical or emotional stress, illness, or surgery, increasing the risk of an adrenal crisis—a sudden, severe episode requiring emergency treatment.

Addisonian Crisis

When the body undergoes extreme stress, and adrenal hormone levels are insufficient to meet the increased demand, it can result in an adrenal (Addisonian) crisis. Symptoms of a crisis include:

  • Severe dehydration

  • Extreme weakness or fatigue

  • Sudden, sharp pain in the lower back, legs, or abdomen

  • Low blood pressure leading to shock

  • Confusion or loss of consciousness

Immediate treatment with intravenous corticosteroids, saline, and glucose is essential to prevent organ failure or death.

Root Causes

The adrenal glands, located on top of the kidneys, consist of an inner medulla and an outer cortex. Addison’s disease primarily affects the adrenal cortex. Several causes can lead to its damage:

Autoimmune Disorders The most common cause is autoimmune adrenalitis, where the immune system mistakenly attacks the adrenal cortex, reducing hormone production.

Infections

  • Tuberculosis (TB)

  • HIV/AIDS

  • Fungal infections

Genetic Conditions

  • Congenital adrenal hyperplasia

  • Adrenoleukodystrophy

Cancers and Metastases

  • Lymphoma

  • Sarcoidosis

Other Causes

  • Adrenal hemorrhage (often after trauma or sepsis)

  • Surgical removal of the adrenal glands

  • Certain medications like ketoconazole or etomidate

Who Is at Risk?

Although Addison's disease can affect anyone, some groups are more vulnerable:

  • Women aged 30–50

  • People with other autoimmune diseases like:

    • Type 1 diabetes

    • Hashimoto’s thyroiditis

    • Graves' disease

    • Vitiligo

Family history of autoimmune or endocrine disorders also increases risk.

Diagnosis Methods

Timely diagnosis can prevent complications. Healthcare providers typically begin with a combination of clinical evaluations and tests:

Blood Tests

  • Cortisol levels: Low morning cortisol (<3 mcg/dL) is a strong indicator

  • ACTH levels: Elevated levels indicate primary adrenal insufficiency

  • Sodium and potassium: Low sodium and high potassium are classic signs

  • Glucose and DHEA levels

ACTH Stimulation Test This is the gold standard for diagnosis. The test measures how well the adrenal glands respond to synthetic ACTH.

Imaging Tests

  • Abdominal CT scan: Evaluates the size and structure of adrenal glands

Other Tests

  • Thyroid function test

  • Antibody screening for autoimmune conditions

Treatment Plans

There is no cure for Addison’s disease, but with proper treatment, patients can live healthy, active lives.

Hormone Replacement Therapy

  • Hydrocortisone (Cortef): Replaces cortisol; typically taken 2–3 times per day

  • Fludrocortisone (Florinef): Replaces aldosterone; regulates salt and water balance

Doses may need adjustment during stress, illness, or surgery to prevent crisis.

Emergency Preparedness Patients are advised to carry a steroid emergency injection kit and wear a medical alert bracelet stating their condition.

Managing an Addisonian Crisis

  • Intravenous hydrocortisone

  • Saline infusion

  • Glucose administration

Lifestyle and Diet

Lifestyle changes and diet play a supportive role in managing Addison’s disease:

Dietary Tips

  • Increased sodium intake (especially for those with aldosterone deficiency)

  • Adequate hydration

  • Avoid processed sugars to manage blood sugar fluctuations

  • Ensure sufficient calcium and vitamin D to prevent osteoporosis

Stress Management

  • Regular physical activity

  • Meditation and breathing techniques

  • Structured sleep schedule

Possible Complications

If not managed properly, Addison’s disease can lead to:

  • Adrenal crisis

  • Chronic fatigue and depression

  • Hypoglycemia

  • Osteoporosis (from long-term corticosteroid use)

  • Infertility or menstrual irregularities

  • Addison’s with secondary autoimmune disorders

Preventive Measures

While Addison’s disease itself cannot be prevented, complications and adrenal crises can be minimized by:

  • Regular medication adherence

  • Monitoring hormone levels

  • Regular follow-up visits with an endocrinologist

  • Wearing medical ID at all times

  • Educating friends and family on emergency procedures

Associated Conditions

Patients with Addison’s disease often develop or have a higher risk of:

  • Type 1 diabetes

  • Autoimmune thyroid disorders

  • Pernicious anemia

  • Celiac disease

  • Vitiligo

Monitoring and managing these conditions in parallel is essential for overall health.

Living With Addison's Disease

Life with Addison’s disease involves daily care, but it doesn’t have to limit your potential. With education, preparedness, and a good healthcare plan, many people lead full, active lives.

Tips for Better Living:

  • Stick to your medication schedule

  • Adjust medications before stressful events

  • Plan regular checkups

  • Maintain a symptom diary

  • Educate your workplace or school about your needs

Many patients find it helpful to connect with support groups or others with adrenal disorders. Sharing experiences can provide emotional support and practical tips.