Addison's Disease

Topic Overview

What is Addison's disease?

Addison's disease develops when the adrenal glands, which are above the kidneys, are not able to make enough of the hormones cortisol and, sometimes, aldosterone.

Cortisol affects almost every organ in the body and is needed for your body to work as it should. The adrenal glands release cortisol to help the body cope with stress from illness, injury, surgery, childbirth, or other reasons. Aldosterone helps the body hold on to the salt it needs, and it keeps your blood pressure steady.

The brain’s hypothalamus and the pituitary gland control the adrenal glands, which in turn make cortisol. The hypothalamus tells the pituitary gland to make a hormone called adrenocorticotropic hormone (ACTH). This hormone tells the adrenal glands to make cortisol. When your adrenal gland cannot make enough cortisol, you have Addison’s disease.

What causes Addison's disease?

Addison's disease most often occurs when the body's immune system kills off the part of the adrenal glands that makes cortisol and aldosterone. It can also form when the adrenal glands are harmed by:

• Cancer that has spread to the adrenal glands. This is mostly seen in lung cancer.
• Bleeding into the adrenal glands as a side effect of using blood thinners.
• Infections, such as tuberculosis, HIV, and some bacterial infections.
• Some types of surgery or radiation treatments.
• The use of certain medicines, such as high doses of ketoconazole.
• Injury to the adrenal glands in the late stages of pregnancy or during childbirth, but this is rare.

People can get Addison's disease at any age. When it is caused by the immune system killing off the adrenal gland, the disease is more common in women, but men are more likely to have Addison’s disease caused by tuberculosis.¹ Addison’s disease can also form if you take a steroid medicine for a long time and then suddenly stop using it.

What are the symptoms?

The most common symptoms are:

• Extreme tiredness (fatigue).
• Weakness.
• Losing weight without trying.

You may also have other symptoms, such as:

• Skin that looks darker than normal.
• Loss of appetite.
• Diarrhea.
• Feeling lightheaded.
• Feeling sick to your stomach or vomiting.
• Craving salt.

And if you have diabetes, you may have low blood sugar more often, and it may be more severe than usual.

Symptoms usually start slowly. You may not even notice them until a stressful event such as a severe infection, trauma, surgery, or dehydration causes an adrenal crisis. An adrenal crisis means that your body can't make enough cortisol to cope with the stress.

In a few cases, Addison's disease gets worse quickly. These people may already be in an adrenal crisis when they see a doctor.

Symptoms of an adrenal crisis include:

• Severe vomiting and diarrhea.
• Sudden pain in the belly, low back, or legs.
• A high fever.
• Feeling very weak or lightheaded.
• Feeling restless, confused, or fearful.
• Having trouble staying awake.

Call your doctor right away if you have these symptoms. If an adrenal crisis is not treated, you could die of shock from a steep drop in blood pressure.

How is Addison's disease diagnosed?

To diagnose Addison’s disease, the doctor will:

• Ask you questions about your symptoms and past health. He or she will want to know if this disease runs in your family and if you have had cancer or tuberculosis or have been infected with HIV.
• Do a physical exam. The doctor will check to see if your skin color is darker than normal, if you have low blood pressure, or if you are dehydrated.
• Order lab tests. Blood tests can show if you have high potassium or low sodium levels. These levels can be a sign of Addison’s disease. You may also have a blood test to check your levels of cortisol and ACTH.

If the diagnosis is still not clear, you may have an ACTH stimulation test, which helps show how your hormone levels react to stress. You will be given a man-made form of ACTH to see if your body makes enough cortisol. Further tests will show if you have Addison’s disease or another problem.

Your doctor may suggest some imaging tests, such as an MRI, after the problem area has been found.

If your doctor thinks that you have Addison’s disease, he or she may start treatment right away, even before you get your test results. If the test results later show that you don't have the disease, your doctor can stop the treatment.

How is it treated?

If you have Addison's disease, you will need to take medicine for the rest of your life to replace the cortisol and aldosterone your body can't make on its own. You may take just one medicine, or you may need more than one. You may need to increase your dose during times of stress or illness. And you may need to add extra salt to your food during hot and humid weather to replace salt lost in your sweat.

If you have an adrenal crisis, you will need treatment in a hospital.

How do you manage life with Addison’s disease?

Finding out that you have Addison’s disease can be scary. But if you get treatment and follow your doctor’s advice, you can lead a long and healthy life. Here are some things you can do at home to help you manage your disease:

• Take your medicine exactly as your doctor tells you to.
• Don't restrict salt in your diet.
• If you have an adrenal crisis, get help right away. Have a shot of emergency medicine ready at your home, work, or school, and in the car. Know when and how to give the medicine. Have instructions written out, and teach someone else how to give you the medicine in case you can't give it to yourself.
• Wear a medical ID tag (such as a medical alert bracelet ). That way, health professionals know to give you a shot of cortisol if you are injured or ill and cannot speak for yourself.
• Be prepared to deal with stress or illness. Talk with your doctor about when you might need to increase the dose of your medicine during minor illness or times of stress. Call your doctor right away if you have signs of a severe infection.

Frequently Asked Questions

Learning about Addison's Disease:	What is Addison's disease? What causes it? What are the symptoms? What is secondary adrenocortical insufficiency? What happens during an adrenal crisis?
Being diagnosed:	How is Addison's disease diagnosed? What happens during a medical history for Addison's disease? What happens during a physical exam for Addison's disease? How is a cortisol level tested? What is an ACTH stimulation test?
Getting treatment:	How is Addison's disease treated? What can I do at home to help with treatment?

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Author:	Caroline Rea, RN, BS, MS	Last Updated: February 20, 2008
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Alan C. Dalkin, MD - Endocrinology
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