(Adrenal Insufficiency; Adrenocortical Hypofunction; Chronic Adrenocortical Insufficiency; Hypoadrenalism)
Addison disease is a disorder of the adrenal glands. The adrenal glands sit on top of the kidneys and make important hormones. Hormones affect systems throughout the body including blood pressure, metabolism, and the immune system.
With Addison disease, the adrenal glands do not make enough of certain hormones. The hormone cortisol is always affected but aldosterone may be low as well. Addison disease may be:
- Primary Addison disease—adrenal gland tissue can not make hormones
- Secondary Addison disease—other hormones that tell adrenal glands what to do are missing or low
A severe complication of Addison's disease is the Addisonian or
. This is a life threatening crisis.
|Addison's occurs because of damage to the cortex.
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Primary Addison disease is caused by damage to the outer layer of the adrenal gland.
This damage can happen slowly overtime for a number of reasons.
Addison disease is most often caused by an autoimmune disease when the immune system begins to attack healthy tissue. In this case, it attacks tissue of the adrenal gland. The cause of autoimmune diseases is unclear.
Damage may also be caused by infections such as:
Less common causes include:
Certain cancers, including those that have spread
Amyloidosis—deposit of abnormal protein in tissue
Bleeding within the adrenal glands—may happen because of anticoagulant medications or
- Surgical removal of glands
- Genetic factors or birth defects that make it difficult for the adrenal glands to work properly
- Certain medications
Secondary Addison disease can be caused by damage to the pituitary gland. The pituitary gland sends hormones that control the adrenal gland. If the pituitary gland is damaged it will affect the adrenal glands.
Adrenal insufficiency may also occur after long term corticosteroids are stopped.
Factors that may increase your chance of Addison's disease include:
Autoimmune disorders, such as:
- Anticoagulant medications
- Abdominal injury
- Family members with autoimmune-caused Addison's disease
Long-term steroid medication treatment, followed by:
- Previous surgery on adrenal glands
- Hereditary disorders, such as Prader-Willi syndrome and congenital adrenal hyperplasia
Symptoms of Addison disease may include:
- Extreme weakness, fatigue
- Weight loss
- Nausea or vomiting
- Muscle weakness
- Darkening of freckles, nipples, scars, skin creases, gums, mouth, nail beds, and vaginal lining
Emotional changes, especially
- Cognitive impairment or confusion
- Craving salty foods
- Abdominal pain
Lack of appetite
Symptoms of an adrenal crisis include:
- High or low body temperature
- Severe abdominal, back, or leg pain
- Severe dehydration
- Severe nausea, vomiting, and diarrhea
- Bluish skin color
- Muscle weakness
You will be asked about your symptoms and medical history. A physical exam will be done. If a problem with hormones is suspected your doctor may order:
- Blood tests and urine tests to measure the amount of cortisol
ACTH stimulation test—should make the adrenal glands release cortisol
- CRH stimulation test—can help determine if it is primary or secondary Addison disease
Imaging tests may be needed to look at the adrenal glands. Tests may include:
Addison disease cannot be cured but can be managed with medication. These medications replace the missing hormones to decrease symptoms. They can also help prevent an adrenal crisis. An adrenal crisis will need immediate medical attention to try to balance the hormones again.
Regular blood tests are needed to monitor your response to medication. Wear a medical alert bracelet that states adrenal insufficiency or Addison disease. This will let others know of your condition if you are unable to communicate.
Cortisol helps the body deal with stress. Those with Addison disease need to take extra care during times of stress. Extra treatment may be needed during physical stress or recovery such as:
- Severe illnesses or injuries
There are no current guidelines to prevent Addison disease.
Family Doctor—American Academy of Family Physicians
National Adrenal Diseases Foundation
The Canadian Addison Society
Adrenal insufficiency and Addison's disease. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at:
http://www.niddk.nih.gov/health-information/health-topics/endocrine/adrenal-insufficiency-Addisons-disease/Pages/fact-sheet.aspx Updated May 14, 2014. Accessed June 4, 2014.
Adrenal insufficiency in adults. EBSCO DynaMed Plus website. Available at:
http://www.dynamed.com/topics/dmp~AN~T116703/Adrenal-insufficiency-in-adults. Updated December 29, 2015. Accessed September 30, 2016.
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