Addison's Disease

Addison's disease is a rare autoimmune disorder in which the adrenal glands do not produce enough of the hormones cortisol and aldosterone. These hormones are essential for regulating metabolism, blood pressure, and stress responses. The disease develops gradually and can become life-threatening if untreated, especially during times of physical stress or illness.

Chronic fatigue; Muscle weakness; Unexplained weight loss; Loss of appetite; Low blood pressure (can cause fainting); Salt cravings; Nausea, vomiting, or abdominal pain; Hyperpigmentation (darkening) of skin, especially in scars or skin creases; Depression or irritability; Low blood sugar (especially in children); Irregular or absent menstrual periods in women.

Most often caused by autoimmune destruction of the adrenal cortex (70-90% of cases in developed countries). Other causes include infections (e.g., tuberculosis, HIV), genetic disorders (e.g., congenital adrenal hyperplasia), cancer metastasis to adrenal glands, or bleeding into the adrenal glands.

ACTH stimulation test (gold standard); Blood tests for low cortisol and high ACTH levels; Electrolyte panel showing low sodium and high potassium; Antibodies to 21-hydroxylase (specific marker in autoimmune Addison's); Imaging (CT scan) of adrenal glands.

Hormone replacement therapy is lifelong: Hydrocortisone, prednisone, or dexamethasone to replace cortisol; Fludrocortisone to replace aldosterone; Emergency treatment with injectable corticosteroids for adrenal crisis; Stress dosing of steroids during illness, surgery, or injury; Medical ID bracelet recommended.

With proper treatment and education, most people live normal lives. Without treatment, adrenal crisis can be fatal. Patients must be vigilant about stress dosing, staying hydrated, and recognizing symptoms of low cortisol.

Estimated 100-140 cases per million in the general population. Affects both men and women equally. Most common between ages 30-50, but can occur at any age.