15095 Addisons Disease

Overview

Addison's disease (also called adrenal insufficiency) is a rare condition where the adrenal glands – two small glands sitting on top of your kidneys – do not make enough of two key hormones: cortisol and aldosterone. Cortisol helps your body respond to stress and keeps inflammation in check. Aldosterone helps control blood pressure and balances salt and water. Without enough of these hormones, your body cannot work normally. With proper treatment, Addison's can be managed well.

No, it's rare. About 1 in 10,000 people have Addison's, so most doctors only see a few cases in their career.

Anyone can get Addison's, but it happens more often in adults between 30 and 50 years old. It affects both men and women, and women are slightly more likely to get it. It can also run in families, especially when linked to other autoimmune conditions.

Symptoms

Common symptoms

• Extreme tiredness (fatigue) that doesn't go away with rest
• Unintentional weight loss and loss of appetite
• Low blood pressure – you may feel light-headed or faint when you stand up
• Darkening of the skin, especially on knuckles, knees, elbows, lips, and inside cheeks
• Salt craving
• Nausea, vomiting, or stomach pain
• Muscle or joint aches
• Mood changes, including feeling irritable, low, or depressed

Symptoms in children

• Poor weight gain and slow growth
• Excessive tiredness and weakness
• Low blood sugar, especially between meals
• Salt craving and stomach aches
• Darkening of skin
• Delayed puberty

Symptoms in older adults

• Vague symptoms like confusion or memory problems
• Unexplained fatigue and weakness
• Feeling faint or falling due to low blood pressure
• Decreased appetite and weight loss
• Nausea, vomiting, or low blood sodium
• May be mistaken for aging or dementia

Causes

Main causes

• Autoimmune attack – your immune system mistakenly damages the adrenal glands. This is the most common cause in high-income countries.
• Infections – such as tuberculosis, which can destroy the adrenal glands.
• Bleeding into the adrenal glands (adrenal hemorrhage) – can happen with serious infections or blood-thinning medicines.
• Cancer that spreads from elsewhere to the adrenal glands.
• Certain medicines that stop the adrenal glands from working.
• Surgical removal of both adrenal glands.

Risk factors

• Having another autoimmune disease, such as type 1 diabetes, thyroid disease, vitiligo, or pernicious anemia.
• A family history of Addison's disease or autoimmune disease.
• Infections like tuberculosis – more common in some parts of the world.
• Long-term use of steroid medicines – if stopped suddenly, can cause adrenal insufficiency.

When to see a doctor

See a doctor urgently if:

• Call your local emergency number immediately if you have symptoms of an adrenal crisis (see emergency symptoms above).
• If you have Addison's and can't keep down your medication or fluids, get urgent care.
• If you have severe abdominal pain, vomiting, and feel faint, seek emergency help.

Book a routine appointment if:

• Make an appointment if you've been feeling unusually tired, losing weight, light-headed, craving salt, or noticing your skin getting darker.
• If you have another autoimmune condition and notice any of these symptoms, see your doctor.
• Book a check-up if symptoms come and go but don't go away.

Diagnosis

Your doctor will ask about your symptoms, medical history, and do a physical examination. Because Addison's is rare, your doctor may use a series of tests to confirm it. The most reliable test is the ACTH stimulation test. ACTH is a hormone that normally 'tells' your adrenal glands to produce cortisol. Doctors measure your cortisol levels before and after giving you a synthetic version of ACTH. If your cortisol does not rise as expected, your adrenal glands are not responding properly, and this points to Addison's.

Tests that may be done

• Blood test for cortisol, ACTH, sodium, potassium, blood sugar, and kidney function.
• ACTH stimulation test – this is the key test.
• Antibody test to see if your immune system is attacking the adrenal glands.
• Imaging tests (like a CT scan) to look at your adrenal glands if an infection, bleeding, or tumor is suspected.

What to expect at your appointment

If the tests suggest Addison's, your doctor will refer you to an endocrinologist (a specialist in hormones) for care. The diagnosis might take a few appointments. Be patient – getting the right answer is the first step to getting better.

Treatment

Addison's disease is treated by replacing the missing hormones (cortisol and aldosterone). This is usually done with tablets you take every day, for life. The goal is to keep hormone levels normal, so your body functions well. You'll work with your specialist to find the right dose for you.

Self-care at home

• Carry a medical alert card or wear a medical alert bracelet that says you have Addison's and what medicine you need.
• Learn your 'sick day rules' – how to adjust your medication during illness, injury, or stress. Your specialist will give you written instructions.
• Always have a supply of your medication, including extra for travel.
• Tell family, friends, and work colleagues what Addison's is and what to do in an emergency.
• Avoid contact with people who are sick when possible, and get prompt medical care if you get an infection.

Medical treatments

Doctors use medicines that replace cortisol and aldosterone. These are taken daily and may need to be increased temporarily when you are under physical stress (like a bad cold, surgery, or serious injury). Some people are taught to give an emergency injection to themselves or a family member in case of a crisis. Always take your medicines exactly as prescribed – never stop or change them on your own. Your endocrinologist will adjust the dose based on your blood tests and how you feel.

When is surgery considered?

Surgery is not usually part of treating Addison's itself. However, if an underlying problem such as a tumor, bleeding, or infection involves your adrenal glands, you might need surgery to remove them. Your specialist team will discuss this with you if it's relevant.

Living with this condition

With daily treatment, most people with Addison's live normal, active lives. You'll need to check in regularly with your endocrinologist and carry your medicines with you. It helps to plan ahead, especially when travelling, exercising, or during stressful periods.

Lifestyle tips

• Take your medication every day at the right time – usually first thing in the morning and again in the afternoon (as prescribed).
• Follow your sick day rules. If you have fever, vomiting, diarrhoea, or need surgery, you may need a higher dose – know what to do.
• Eat regular meals and snacks to keep your energy and blood sugar steady.
• Stay hydrated, especially in hot weather or after exercise.
• Wear medical identification at all times so first responders know about your condition.

Diet and exercise

A balanced, healthy diet is important. Most people need a little more salt than the average person because aldosterone helps control salt balance. Don't go on a very low-salt diet. Your doctor or dietitian can give you personal advice. Exercise is safe, but listen to your body. Drink plenty of fluids and rest when needed. If you sweat a lot, you may need extra salt and fluids – talk to your care team.

Mental health and emotional wellbeing

Living with any long-term condition can be stressful. You may feel frustrated, anxious, or down. These feelings are normal and nothing to be embarrassed about. Talk to your healthcare team about how you feel – they can connect you to a counsellor or support group if needed. Reaching out to other people who have Addison's can be reassuring. If you ever feel in crisis or have thoughts of self-harm, please call your local emergency number or a crisis line right away.

Prevention

Most cases of Addison's cannot be prevented, because they happen when your immune system mistakenly attacks your own tissues. But with early diagnosis, you can prevent dangerous adrenal crises. If you take steroid medicines for another condition, work with your doctor to come off them slowly – never stop suddenly – this can prevent steroid-induced adrenal insufficiency.

Vaccines

Staying up to date with recommended vaccines helps protect you from infections, which can be harder on people with Addison's. Always tell your vaccination provider you have Addison's. Vaccines are safe but may need to be planned around your treatment.

Screening programmes

There is no routine screening for Addison's in the general population. However, if you have a condition that puts you at higher risk (like an autoimmune disease), your doctor may test your hormone levels from time to time.

Complications

If left untreated

• Adrenal crisis – a life-threatening emergency with severe low blood pressure, shock, vomiting, and dehydration.
• Dangerously low blood sodium (hyponatraemia) – can cause confusion, seizures, and coma.
• High blood potassium (hyperkalaemia) – can affect the heart rhythm and cause cardiac arrest.
• Severe fatigue and weakness leading to disability.
• In children, failure to grow and develop normally.

Long-term outlook

With treatment, the outlook is excellent. Most people with Addison's live as long and as fully as anyone else. The key is taking your medication every day, following your sick day rules, and getting quick medical help when you feel unwell. Yes, it's a serious condition if untreated, but with the right care, you can enjoy a full, active life.

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