Addisons' disease is a rare chronic condition in which your adrenal glands don’t produce enough of the hormones cortisol and aldosterone. It's most often caused by an autoimmune attack. It's treatable with medication.
The most common cause of Addison’s disease is an autoimmune response, which occurs when your immune system attacks healthy tissues for an unknown reason.
With Addison’s disease, your immune system attacks the outer portion of your adrenal glands (the adrenal cortex), where they make cortisol and aldosterone.
Symptoms don’t usually develop until 90% of the adrenal cortex has been damaged, which can take several months to years.
Other less common causes of Addison’s disease include:
Repeated infections, including HIV/AIDS-related infections and fungal infections.
When cancer cells from another part of your body invade your adrenal glands.
Bleeding (hemorrhaging) into your adrenal glands.
Surgical removal of your adrenal glands.
Amyloidosis (a condition in which amyloid proteins build up in vital organs, causing damage).
Steadily worsening fatigue (most common symptom).
Patches of dark skin (hyperpigmentation), especially around scars and skin creases and on your gums.
Nausea and vomiting.
Loss of appetite and unintentional weight loss.
Muscle pain, muscle spasms and/or joint pain.
Low blood pressure, which can cause lightheadedness or dizziness upon standing.
Changes in mood and behavior, such as irritability, depression and poor concentration.
A craving for salty food.
Low blood sugar (hypoglycemia).
Your provider will likely order certain tests to measure the levels of sodium, potassium, cortisol and ACTH in your blood.
ACTH stimulation test
This test measures your adrenal glands’ response after you’re given a shot of artificial ACTH. If your adrenal glands produce low levels of cortisol after the shot, they may not be functioning properly.
Insulin-induced hypoglycemia test
Your provider may order this test to determine if your symptoms are due to problems with your pituitary gland (secondary adrenal insufficiency) instead of your adrenal glands
This test measures blood sugar (glucose) levels before and after the injection of fast-acting insulin, which should lead to a drop in blood sugar (hypoglycemia) and a rise in cortisol.
Computed tomography (CT scan)
Computed tomography is an imaging test that uses computers to combine many X-ray images into cross-sectional views.
Your provider may order a CT scan to evaluate your adrenal glands and/or pituitary gland.
For example, it can show if your immune system has damaged your adrenal glands or if the glands are infected.
Addison’s disease is treated by replacing the missing hormones, cortisol and aldosterone, with synthetic versions of them.
Cortisol is replaced by the drug hydrocortisone, and aldosterone is replaced by the drug fludrocortisone.
Addison’s disease is a chronic condition, so you’ll need to take medication for the rest of your life.
The dosages of these medications are different for each person, and your healthcare provider may increase the dosage when you’re experiencing an infection, trauma, surgery and other stressful situations to prevent an acute adrenal crisis.
If you’re taking fludrocortisone, your provider might tell you to increase your salt intake, especially in hot and humid weather and after vigorous exercise.