Diseases and Conditions

Adrenal Insufficiency/Addison's Disease

What is adrenal insufficiency/Addison’s disease?

Adrenal insufficiency occurs when the adrenal glands don’t make enough of the hormone cortisol. The adrenal glands are found just above each kidney. They work with the hypothalamus and pituitary glands in the brain. Cortisol helps break down fats, proteins, and carbohydrates in your body. It also affects how your immune system works.

Adrenal insufficiency can be either primary or secondary. The primary kind is known as Addison's disease. It occurs when the adrenal glands are damaged. They don’t make enough of the hormones cortisol and aldosterone. Addison's disease is rare. It may occur at any age.

Secondary adrenal insufficiency starts with a problem with the pituitary gland in the brain. The gland does not make enough adrenocorticotropin hormone (ACTH). As a result the adrenal glands don’t make enough cortisol.

What causes adrenal insufficiency/Addison's disease?

The most common cause is when your immune system starts to attack the adrenal glands. Other causes may include:

  • Cancer
  • Fungal infections
  • Tuberculosis infection of the adrenal glands 
  • Inherited disorders of the endocrine glands

A lack of ACTH leads to the secondary kind. That can happen if you take certain steroids for a long time. For example, people with asthma or rheumatoid arthritis may need to take prednisone. Other causes include:

  • Pituitary gland tumors
  • Loss of blood flow to the pituitary 
  • Pituitary gland is removed or you have radiation treatment of the pituitary gland
  • Parts of the hypothalamus are removed

What are the symptoms of adrenal insufficiency/Addison's disease?

You may have mild symptoms when you are under physical stress. Each person has symptoms in a different way. These are the most common symptoms:

  • Weakness
  • Fatigue
  • Dizziness
  • Dark skin (Addison's disease only)
  • Bluish-black color around the nipples, mouth, rectum, scrotum, or vagina (Addison's disease only)
  • Weight loss
  • Dehydration
  • Lack of appetite
  • Muscle aches
  • Nausea
  • Vomiting
  • Diarrhea
  • Low blood pressure
  • Low sugar levels
  • In women, irregular or no menstrual periods

If not treated, Addison's disease may lead to:

  • Severe abdominal pain
  • Extreme weakness
  • Low blood pressure
  • Kidney failure
  • Shock

These symptoms may look like other health problems. Always see your health care provider for a diagnosis.

How is adrenal insufficiency/Addison's disease diagnosed?

Your health care provider will ask about your past health. You will also need an exam. Tests that can diagnose Addison's disease may include:

  • Blood and urine tests to measure levels of the adrenal hormone
  • Radiology tests, such as X-rays, ultrasound, and MRI

How is adrenal insufficiency/Addison's disease treated?

Your health care provider will figure out the best treatment for you based on:

  • How old you are
  • Your overall health and past health
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

You will need to take hormones to replace those that your adrenal glands are not making. That mainly means cortisol. But if you have Addison's disease, you may need to take aldosterone.

Addison's disease can be life threatening. So treatment often starts with corticosteroids. You may take them by mouth or by IV. You may have to take this medicine the rest of your life. You may also need to take fludrocortisones. They can help keep the levels of sodium and potassium normal in your body.

What are the complications of adrenal insufficiency/Addison’s disease?

You can have acute adrenal insufficiency or Addisonian crisis. It can occur when your body is stressed. It can happen for a number of reasons, including an illness, fever, surgery, or dehydration. You may also have a crisis if you stop taking or lower the amount of your steroids suddenly. The symptoms of an Addisonian crisis include those of adrenal insufficiency or Addison’s disease. If an Addisonian crisis is not treated, it can lead to:

  • Shock
  • Seizures
  • Coma

Living with adrenal insufficiency/Addison’s disease

Take your medicine exactly as prescribed. You should also carry a medical alert card or tag at all times. It can make sure you get proper treatment in the case of an emergency. When traveling always carry an emergency kit with a shot of cortisol.

When should I call my health care provider?

Any condition that stresses your body can affect how much medicine you need. Call your health care provider if:

  • You have any kind of illness, especially a fever, vomiting, or diarrhea
  • You become pregnant
  • You need to have surgery

Get medical help right away if you have sudden severe symptoms (Addisonian crisis).

Key points about adrenal insufficiency/Addison’s disease

  • Adrenal insufficiency occurs when the adrenal glands don’t make enough of the hormone cortisol.
  • The primary kind is known as Addison’s disease. It is rare. It occurs when the adrenal glands don’t make enough of the hormones cortisol and aldosterone.
  • Secondary adrenal insufficiency occurs when the pituitary gland in the brain doesn’t make enough adrenocorticotropin hormone (ACTH). The adrenal glands then don’t make enough cortisol.
  • Mild symptoms may be seen only when a person is under physical stress. Other symptoms may include weakness, fatigue, and weight loss.
  • Blood and urine tests can help diagnose this health problem. They measure the level of adrenal hormone in the body.
  • You will need to take hormones to replace those that the adrenal glands are not making.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

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