Addison’s Disease

 

Addison’s Disease: Causes, Symptoms, Diagnosis, and Treatment

Addison’s disease, also known as primary adrenal insufficiency, is a rare disorder that occurs when the adrenal glands fail to produce enough vital hormones, mainly cortisol and often aldosterone. The condition develops gradually and may become life-threatening if left untreated. Early recognition and proper hormone replacement therapy are essential for managing the disease.

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Key Symptoms

Addison’s disease usually develops slowly over months. Symptoms may worsen suddenly during physical stress.

Common Early Symptoms

• Severe fatigue and weakness

• Dizziness when standing (low blood pressure)

• Low blood sugar with sweating

• Nausea, vomiting, or diarrhea

• Abdominal pain

• Muscle or joint pain

• Loss of appetite and unintentional weight loss

• Craving salty foods

Physical Changes

• Darkening of the skin, especially scars and skin folds

• Loss of body hair

Emotional and Mental Symptoms

• Irritability

• Depression

• Reduced libido in women

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Adrenal Crisis (Medical Emergency)

An adrenal crisis occurs when symptoms worsen rapidly. It requires immediate medical attention.

Emergency signs include:

• Severe weakness

• Intense abdominal or back pain

• Persistent vomiting or diarrhea

• Dehydration

• Low blood pressure or fainting

• Confusion or loss of consciousness

• High fever

Without urgent treatment, adrenal crisis can be fatal.

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Causes

Addison’s disease results from damage to the adrenal cortex.

Common causes:

• Autoimmune destruction (most common)

• Tuberculosis or other infections

• Metastatic cancer

• Adrenal bleeding

• Genetic disorders such as congenital adrenal hyperplasia

• Medications that block cortisol production (e.g., ketoconazole)

Secondary Adrenal Insufficiency

Occurs when the pituitary gland does not release enough ACTH.
Symptoms are similar but without skin darkening and with a higher risk of low blood sugar.

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Risk Factors

• Autoimmune endocrine diseases

• Pituitary disorders or surgery

• Genetic adrenal or pituitary conditions

• Severe head injuries

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Complications

If untreated, Addison’s disease can lead to:

• Adrenal crisis

• Low blood pressure

• Low blood sugar

• High potassium levels

These complications require immediate treatment.

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Diagnosis

Diagnosis includes:

• Blood tests for cortisol, sodium, potassium, and ACTH

• ACTH stimulation test

• Insulin-induced hypoglycemia test (for secondary insufficiency)

• CT scan of the adrenal glands

• MRI of the pituitary gland

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Treatment

Treatment focuses on replacing missing hormones:

• Hydrocortisone, prednisone, or methylprednisolone for cortisol replacement

• Fludrocortisone for aldosterone replacement

• Increased sodium intake during heat, heavy exercise, or illness

Patient Recommendations

• Carry a medical alert card or bracelet

• Keep extra medication available at all times

• Learn how to use emergency steroid injections

• Regular follow-ups to adjust doses

• Seek urgent care if vomiting prevents taking oral medication

Adrenal Crisis Treatment

• IV corticosteroids

• IV saline

• IV glucose