DefinitionAddison's disease is a disorder that occurs when the adrenal glands do not produce enough of their hormones.
Alternative NamesAdrenocortical hypofunction; Chronic adrenocortical insufficiency; Primary adrenal insufficiency
Causes, incidence, and risk factorsThe adrenal glands are small hormone-releasing organs located on top of each kidney. They are made up of the outer portion (called the cortex) and the inner portion (called the medulla).The cortex produces three types of hormones:The glucocorticoid hormones (such as cortisol) maintain sugar (glucose) control, decrease (suppress) immune response, and help the body respond to stress.The mineralocorticoid hormones (such as aldosterone) regulate sodium and potassium balance.The sex hormones, androgens (male) and estrogens (female), affect sexual development and sex drive.Addison's disease results from damage to the adrenal cortex. The damage causes the cortex to produce less of its hormones.This damage may be caused by the following:The immune system mistakenly attacking the gland (autoimmune disease)Infections such as tuberculosis, HIV, or fungal infectionsHemorrhage, blood lossTumorsUse of blood-thinning drugs (anticoagulants)Risk factors for the autoimmune type of Addison's disease include other autoimmune diseases:Chronic thyroiditisDermatis herpetiformisGraves' diseaseHypoparathyroidismHypopituitarismMyasthenia gravisPernicious anemiaTesticular dysfunctionType I diabetesVitiligoCertain genetic defects may cause these conditions.
SymptomsChanges in blood pressure or heart rateChronic diarrhea, nausea, and vomiting, or loss of appetite resulting in weight lossDarkening of the skin in some places, causing the skin to look patchy
PalenessExtreme weakness, fatigue, and slow, sluggish movement
Mouth lesions on the inside of a cheek (buccal mucosa)Salt craving
Signs and testsTests may show:Increased potassiumLow blood pressureLow cortisol levelLow serum sodiumNormal sex hormone levelsOther tests may include:Abdominal x-rayAbdominal CT scanThis disease may also change the results of the following tests:17-hydroxycorticosteroids17-ketosteroids24-hour urinary aldosterone excretion rateACTHAldosteroneBlood eosinophil countCO2Cortrosyn stimulation testPotassium testReninUrine cortisol
TreatmentTreatment with replacement corticosteroids will control the symptoms of this disease. However, you will usually need to take these drugs for life. People often receive a combination of glucocorticoids (cortisone or hydrocortisone) and mineralocorticoids (fludrocortisone).Never skip doses of your medication for this condition, because life-threatening reactions may occur.The health care provider may increase the medication dose because of:InfectionInjuryStressSurgeryDuring an extreme form of adrenal insufficiency, called adrenal crisis, you must inject hydrocortisone immediately. Supportive treatment for low blood pressure is usually needed as well.Some people with Addison's disease are taught to give themselves an emergency injection of hydrocortisone during stressful situations. It is important for you to always carry a medical identification card that states the type of medication and the proper dose you need in case of an emergency. Your health care provider may also tell you to always wear a Medic-Alert tag (such as a bracelet) alerting health care professionals that you have this condition in case of emergency.
Expectations (prognosis)With hormone replacement therapy, most people with Addison's disease are able to lead normal lives.
ComplicationsComplications can occur if you take too little or too much adrenal hormone supplement.Complications also may result from the following related illnesses:DiabetesHashimoto's thyroiditis (chronic thyroiditis)HypoparathyroidismOvarian hypofunction or testicular failurePernicious anemiaThyrotoxicosis
Calling your health care providerCall your health care provider if:You are unable to keep your medication down due to vomiting.You have been diagnosed with Addison's disease, and you have stress such as infection, injury, trauma, or dehydration. You may need to have your medication adjusted.Your weight increases over time.Your ankles begin to swell.You develop other new symptoms.If you have symptoms of adrenal crisis, give yourself an emergency injection of your prescribed medication. If it is not available, go to the nearest emergency room or call 911.Symptoms of adrenal crisis include:Abdominal painDifficulty breathingDizziness or light-headednessLow blood pressureReduced consciousness
ReferencesStewart PM, Krone NP. The adrenal cortex. In: Kronenberg H, Melmed S, Polonsky K, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 15.