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21-hydroxylase antibodies (present in autoimmune Addison’s)
May also see other antibodies if part of autoimmune polyglandular syndrome (APS)
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
Bleeding into the adrenal glands (e.g., in sepsis or trauma)
ACTH stimulation test (gold standard): measures cortisol response to synthetic ACTH
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 to check for enlargement, calcification, or shrinkage
Hormone replacement therapy is lifelong:
Hydrocortisone, prednisone, or dexamethasone to replace cortisol
Fludrocortisone to replace aldosterone
Emergency treatment with injectable corticosteroids (e.g., Solu-Cortef) 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
Ten, S., New, M., & Maclaren, N. (2001). Addison’s disease 2001. The Journal of Clinical Endocrinology & Metabolism, 86(7), 2909-2922.
NIH – National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov
Betterle, C., & Morlin, L. (2011). Autoimmune Addison’s disease. Endocrine Development, 20, 161–172.
Mayo Clinic. Addison’s disease overview. https://www.mayoclinic.org
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