Addison's Disease

Overview

What is Addison's disease?

Addison’s disease, also known as primary adrenal insufficiency, is a rare but serious condition where the adrenal glands don’t produce enough of two essential hormones: cortisol and aldosterone. Cortisol helps the body respond to stress, while aldosterone balances sodium and potassium in the blood. Without them, the body struggles to regulate blood pressure, fluid balance, and even energy levels.

What’s the difference between Addison's disease and Cushing's syndrome?

While Addison’s disease is caused by too little cortisol, Cushing’s syndrome comes from having too much of it. The two conditions sit on opposite ends of the hormonal spectrum. Addison’s results in fatigue, low blood pressure, and weight loss, while Cushing’s leads to weight gain, high blood pressure, and excess fat deposits, particularly around the midsection.

Who does Addison’s disease affect?

Addison’s disease can affect anyone, but it often appears between the ages of 30 and 50. Both men and women are equally at risk. In regions where tuberculosis (TB) remains more common such as parts of sub-Saharan Africa TB can be a leading cause of adrenal gland damage, making Addison’s more prevalent compared to high-income countries where autoimmune disorders are the main culprit.

How common is Addison’s disease?

Globally, Addison’s is considered rare, affecting roughly 1 in 100,000 people. However, diagnosis can be delayed, especially in resource-limited health systems where adrenal disorders may be overlooked. In such settings, Addison’s may be underreported, leaving many without timely care.

Symptoms and Causes

What are the symptoms of Addison’s disease?

Symptoms often develop gradually, making the condition difficult to spot early. Persistent fatigue, unexplained weight loss, muscle weakness, and darkening of the skin (hyperpigmentation) are classic signs. Many people also experience low blood pressure, dizziness upon standing, and salt cravings. In some cases, symptoms may escalate suddenly into an Addisonian crisis, a medical emergency marked by severe dehydration, sharp abdominal pain, confusion, and dangerously low blood pressure.

What causes Addison’s disease?

In most high-income countries, autoimmune disease is the leading cause of Addison’s. The immune system mistakenly attacks the adrenal glands, leaving them unable to produce hormones. In many African countries, however, infectious diseases like tuberculosis remain a significant cause. Other triggers include long-term fungal infections, adrenal cancer, or bleeding into the adrenal glands.

Diagnosis and Tests

How is Addison’s disease diagnosed?

Diagnosis often begins with a thorough review of medical history, symptom patterns, and physical examination. Because symptoms mimic other conditions, doctors need targeted tests to confirm adrenal insufficiency.

What tests will be done to diagnose Addison’s disease?

The gold standard is the ACTH (adrenocorticotropic hormone) stimulation test. It measures how well the adrenal glands respond when stimulated. Blood tests for sodium, potassium, cortisol, and ACTH levels are also common. Imaging scans, such as CT or MRI, may be used to assess the size and structure of the adrenal glands.

Management and Treatment

How is Addison’s disease treated?

Treatment is lifelong but highly effective. Patients typically take hormone replacement therapy hydrocortisone, prednisone, or dexamethasone for cortisol, and fludrocortisone for aldosterone. Education is also key. Patients are often advised to carry an emergency injection of hydrocortisone in case of Addisonian crisis. In addition, adjusting medication during illness, surgery, or periods of extreme stress is crucial to prevent complications.

Outlook / Prognosis

What is the prognosis (outlook) for Addison’s disease?

With proper diagnosis and treatment, people with Addison’s disease can live long and productive lives. However, the risk of an Addisonian crisis means patients must remain vigilant, particularly in areas where emergency medical services are limited. Early recognition, adherence to treatment, and access to healthcare significantly improve outcomes.

Prevention

Can Addison’s disease be prevented?

There is no known way to prevent autoimmune-related Addison’s disease. However, reducing the prevalence of preventable causes, such as tuberculosis, through vaccination and early treatment programs can lower the risk in some regions. Prompt management of infections and awareness of adrenal health are valuable preventive measures.

Living With

How do I take care of myself if I have Addison’s disease?

Daily management involves taking prescribed medication consistently, monitoring for signs of hormone imbalance, and maintaining a balanced diet with adequate salt intake. Many patients wear a medical alert bracelet, ensuring that emergency teams can quickly identify the condition. Staying informed and preparing for stressful situations with extra medication are key steps in living well with Addison’s.

When should I see my healthcare provider about Addison’s disease?

Regular follow-up is essential. Patients should seek medical attention if they notice worsening fatigue, unexplained weight changes, frequent dizziness, or new symptoms. Emergency care is critical if severe weakness, vomiting, or fainting occurs, as these may signal an Addisonian crisis.

Published 16th Oct 2025

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