Addisons disease

Overview

Addison’s disease is a rare condition where the adrenal glands (small glands on top of each kidney) do not produce enough of the hormones cortisol and aldosterone. These hormones help your body handle stress, maintain blood pressure, and balance salt and water. Without enough of them, your body cannot function normally if you are ill or injured.

No, Addison’s disease is rare. It affects about 1 in 10,000 to 20,000 people worldwide.

It can affect people of any age, but it is most often diagnosed in adults between 30 and 50 years old. It is slightly more common in women.

Symptoms

Common symptoms

• Feeling very tired and weak
• Weight loss and loss of appetite
• Low blood pressure, which can make you feel dizzy when standing up
• Darkening of the skin in places like the elbows, knuckles, and inside the cheeks (like a deep tan that does not go away)
• Craving salty foods
• Stomach pain, nausea, or vomiting

Symptoms in children

• Children may have poor growth or delayed puberty
• They can also have the same general symptoms as adults, like fatigue, weight loss, and salt craving

Symptoms in older adults

• Symptoms in older adults can be mistaken for other age-related problems, such as general weakness or dementia
• They may have low blood pressure that leads to falls

Causes

Main causes

• Autoimmune reaction: the body’s immune system attacks and destroys the adrenal glands (this is the most common cause)
• Infections such as tuberculosis, fungal infections, or HIV
• Cancer that spreads to the adrenal glands
• Bleeding into the adrenal glands (e.g., from a severe injury or certain blood thinners)

Risk factors

• Having another autoimmune disease, such as type 1 diabetes, Hashimoto’s thyroiditis, or vitiligo
• A family history of Addison’s disease
• Living in areas where tuberculosis is common

When to see a doctor

See a doctor urgently if:

• If you have symptoms of an adrenal crisis – vomiting, severe weakness, confusion, or fainting
• If you have Addison’s disease and are sick with fever or vomiting and cannot keep your medication down

Book a routine appointment if:

• If you have ongoing fatigue, weight loss, or darkening of your skin without a known cause
• If you often feel dizzy when standing up or crave salt

Diagnosis

Doctors diagnose Addison’s disease using blood tests and a special test called the ACTH stimulation test. They check your cortisol levels and other hormones.

Tests that may be done

• Blood tests for cortisol and aldosterone
• ACTH stimulation test – a shot of ACTH (a hormone) to see how the adrenal glands respond
• Blood tests for renin and electrolytes (salt levels)
• Sometimes a CT scan of the adrenal glands

What to expect at your appointment

You will likely see an endocrinologist (a hormone specialist). The tests are usually done in a hospital or clinic. You may need to stop taking certain medicines before the test, so follow your doctor’s instructions. The diagnosis may take a few days.

Treatment

Treatment for Addison’s disease involves replacing the hormones your adrenal glands are not making. You will take medication every day, usually as tablets. You may also need a corticosteroid injection kit in case of emergency.

Self-care at home

• Always wear a medical alert bracelet or carry a card that says you have Addison’s disease
• Learn how to give yourself an emergency injection of corticosteroids if your doctor has prescribed it
• Have a sick-day plan – know when to double your medication during illness, injury, or stress
• Avoid skipping meals or getting dehydrated
• Tell your healthcare team about all your medicines, including over-the-counter ones

Medical treatments

Your doctor will prescribe hormone replacement therapy. This includes one type of medication to replace cortisol (a steroid) and another to replace aldosterone (a mineralocorticoid). The doses are individualised and may need adjusting during illness or stress. Never stop your medication suddenly without medical advice.

When is surgery considered?

Surgery is not usually needed for Addison’s disease itself. However, if the cause is a tumour or other growth in the adrenal glands, surgery may be recommended.

Living with this condition

Living with Addison’s disease means taking your medication every day as prescribed and being aware of when you might need extra doses (for example, during infections, surgery, or emotional stress). Many people lead normal lives with regular check-ups.

Lifestyle tips

• Get enough sleep and manage stress
• Avoid extreme physical exertion without planning ahead (for example, carry extra medication when exercising)
• Stay hydrated and eat enough salt, especially in hot weather or after sweating
• Learn to recognise early signs of an adrenal crisis, like extreme fatigue or stomach upset

Diet and exercise

Eat a well-balanced diet with sufficient sodium (salt) – your doctor will advise on how much. Moderate exercise is fine, but avoid overtraining. Always carry your emergency medication during physical activity.

Mental health and emotional wellbeing

Having a chronic condition can be stressful and may lead to anxiety or depression. It is normal to feel frustrated or worried about adrenal crisis. Talk to your doctor or a mental health professional if you need support.

Prevention

Addison’s disease cannot be prevented because it is usually caused by an autoimmune process or infection. However, early treatment can prevent complications.

Vaccines

Staying up to date with routine vaccinations (such as flu and pneumococcal vaccines) is very important because infections can trigger an adrenal crisis. Talk to your doctor about which vaccines you need.

Screening programmes

There is no routine screening for Addison’s disease in the general population. But if you have a family history of autoimmune disease, your doctor might monitor you for symptoms.

Complications

If left untreated

• Adrenal crisis: a life-threatening drop in blood pressure and electrolyte imbalance
• Severe dehydration and shock
• Coma
• If not treated quickly, adrenal crisis can be fatal

Long-term outlook

With proper treatment and self-management, people with Addison’s disease can lead a full and active life. The outlook is excellent – you just need to stay on top of your medication and have a plan for sick days. Many people live just as long and as healthily as people without the condition.

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