Health Encyclopedia

Addison’s disease

Definition

Addison's disease is a disorder that occurs when the adrenal glands do not produce enough of their hormones.

Alternative Names

Adrenocortical hypofunction; Chronic adrenocortical insufficiency; Primary adrenal insufficiency

Causes, incidence, and risk factors

The adrenal glands are small hormone-secreting organs located on top of each kidney. They consist of the outer portion (called the cortex) and the inner portion (called the medulla).

The cortex produces 3 types of hormones:

The glucocorticoid hormones (such as cortisol) maintain sugar (glucose) control, decrease (suppress) immune response, and help the body respond to stress.
The mineralocorticoid hormones (such as aldosterone) regulate sodium and potassium balance.
The sex hormones, androgens (male) and estrogens (female), affect sexual development and sex drive.

Addison's disease results from damage to the adrenal cortex. The damage causes the cortex to produce less of its hormones.

This damage may be caused by the following:

The immune system mistakenly attacking the gland (autoimmune disease)
Infections such as tuberculosis, HIV, or fungal infections
Hemorrhage, blood loss
Tumors
Use of blood-thinning drugs (anticoagulants)

Risk factors for the autoimmune type of Addison's disease include other autoimmune diseases:

Certain genetic defects may cause these conditions.

Symptoms

Changes in blood pressure or heart rate
Chronic diarrhea
Darkening of the skin - patchy skin color
Unnaturally dark color in some places
Paleness
Extreme weakness
Fatigue
Loss of appetite
Mouth lesions on the inside of a cheek (buccal mucosa)
Nausea and vomiting
Salt craving
Slow, sluggish movement
Unintentional weight loss

Signs and tests

Tests may show:

Increased potassium
Low blood pressure
Low cortisol level
Low serum sodium
Normal sex hormone levels

Other tests may include:

This disease may also change the results of the following tests:

17-hydroxycorticosteroids
17-ketosteroids
24-hour urinary aldosterone excretion rate
ACTH
Aldosterone
Blood eosinophil count
CO2
Cortrosyn stimulation test
Potassium test
Renin
Urine cortisol

Treatment

Treatment with replacement corticosteroids will control the symptoms of this disease. However, you will usually need to take these drugs for life. People often receive a combination of glucocorticoids (cortisone or hydrocortisone) and mineralocorticoids (fludrocortisone).

The health care provider may increase the medication dose in times of:

Infection
Injury
Stress

During an extreme form of adrenal insufficiency, adrenal crisis, you must inject hydrocortisone immediately. Supportive treatment for low blood pressure is usually needed as well.

Some people with Addison's disease are taught to give themselves an emergency injection of hydrocortisone during stressful situations. It is important for you to always carry a medical identification card that states the type of medication and the proper dose needed in case of an emergency.

Never skip doses of your medication for this condition, because life-threatening reactions may occur.

Expectations (prognosis)

With hormone replacement therapy, most people with Addison's disease are able to lead normal lives.

Complications

Complications can occur if you take too little or too much adrenal hormone supplement.

Complications also may result from the following related illnesses:

Diabetes
Hashimoto's thyroiditis (chronic thyroiditis)
Hypoparathyroidism
Ovarian hypofunction or testicular failure
Pernicious anemia
Thyrotoxicosis

Calling your health care provider

Call your health care provider if:

You are unable to keep your medication down due to vomiting.
You have been diagnosed with Addison's disease, and you have stress such as infection, injury, trauma, or dehydration. You may need to have your medication adjusted.
Your weight increases over time.
Your ankles begin to swell.
You develop other new symptoms.

If you have symptoms of adrenal crisis, give yourself an emergency injection of your prescribed medication. If it is not available, go to the nearest emergency room or call 911.

Symptoms of adrenal crisis include:

Abdominal pain
Difficulty breathing
Low blood pressure
Reduced consciousness

References

Stewart PM. The adrenal cortex. In: Kronenberg H, Melmed S, Polonsky K, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, PA: Saunders Elsevier; 2008:chap 14.

Review Date:3/18/2008
Reviewed By:Elizabeth H. Holt, MD, PhD, Assistant Professor of Medicine, Section of Endocrinology and Metabolism, Yale University. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.

Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.