Health Library

Addison's Disease

(Adrenal Insufficiency; Adrenocortical Hypofunction; Chronic Adrenocortical Insufficiency; Hypoadrenalism)

Definition

Addison's disease is a rare disorder of the adrenal glands. With Addison's, the adrenal glands do not produce enough of the hormones cortisol and aldosterone.

Adrenal Glands

Addison's occurs because of damage to the cortex.

Causes

Addison's disease is the result of gradual damage to the outer layer of the adrenal gland. This damage may be caused by:

The body's own immune system attacking the gland. Known as an autoimmune disease. This cause accounts for 85% of cases in developed countries.

Tuberculosis —major cause in the Third World countries
Bleeding within the adrenal glands—related to use of anticoagulant medications and shock [extremely low blood pressure]
Surgical complication
Condition that are present at birth or due to genetic factors (enzyme defects, familial glucocorticoid insufficiency)
Cytomegalovirus (CMV) infection associated with AIDS
Fungal infections, including:
- Blastomycosis
- Histoplasmosis
- Coccidioidomycosis
Cancer including metastases from:
- Breast, lung, kidney, or colon cancer
- Lymphoma
- Kaposi's sarcoma
Medications (such as ketoconazole or etomidate)
Radiation treatment
Chronic illness, including:
- Sarcoidosis
- Hemochromatosis
- Amyloidosis
- Adrenoleukodystrophy
- Adrenomyelodystrophy

Risk Factors

Factors that increases your chance of getting Addison's disease include:

Having the following autoimmune diseases:
Stress
Anticoagulant medications
Abdominal injury
Family members with autoimmune-caused Addison's disease
Long-term steroid medication treatment, followed by:
- Severe stress
- Infection
- Surgery
- Trauma
Previous surgery on adrenal glands

Symptoms

Symptoms may include:

Extreme weakness, fatigue

Weight loss

Nausea or vomiting

Chronic diarrhea
Muscle weakness
Darkening of freckles, nipples, scars, skin creases, gums, mouth, nail beds, and vaginal lining
Emotional changes, especially depression
Craving for salty foods
Abdominal pain
Anorexia
Amenorrhea

A severe complication of Addison's disease is the Addisonian or adrenal crisis . Adrenal crisis is a life threatening disorder, its symptoms include:

Severe abdominal, back, or leg pain
Fainting
Severe low blood pressure
Severe dehydration
Severe nausea, vomiting, and diarrhea
Low blood sugar
Generalized muscle weakness

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include:

Blood and urine tests—to see if you have low levels of cortisol and aldosterone, high level of adrenocorticotropic hormone (ACTH is a hormone that stimulates the adrenal glands), and to measure levels of:
- Sodium
- Chloride
- Calcium
- Potassium
- Bicarbonate
- Blood urea nitrogen levels
- Anti-adrenal antibody (rarely done)
ACTH stimulation test —measures cortisol in the blood before and after an injection of ACTH

Your doctor may also need images of the abdomen and adrenal glands. This images may be taken with:

Treatment

Symptoms of Addison's disease can be controlled with medicines. These drugs replace the missing hormones. Medicine needs to be taken for the rest of your life. They may need to be increased during times of stress.

Immediate treatment of adrenal crisis includes:

Self-injection of dexamethasone
Hydrocortisone by IV
Normal saline by IV

Regular blood tests are needed to monitor your response to medicine. Wear a medical alert bracelet that states adrenal insufficiency or Addison's disease. This will let others know of your condition if you are unable to communicate.

Prevention

There are no guidelines for preventing Addison's disease. If you think you are at risk, talk to your doctor.

Addison's Disease.net

http://www.addisonsdisease.net/

The Adrenoleukodystrophy Foundation

http://www.aldfoundation.org/

National Adrenal Diseases Foundation

http://www.nadf.us/

The Canadian Addison Society

http://www.addisonsociety.ca/

Health Canada

http://www.hc-sc.gc.ca/

Adrenocortical insufficiency. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated May 2, 2012. Accessed December 31, 2012.

Addison's disease. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health/endo/pubs/addison/addison.htm. Accessed December 31, 2012.

Arlt W, Allolio B. Adrenal insufficiency. Lancet. 2003;361(9372):1881-1893.

Dorin RI, Qualls CR, Crapo LM. Diagnosis of adrenal insufficiency. Ann Int Med. 2003;138:3:194-214.

Hahner S, Allolio B. Therapeutic management of adrenal insufficiency. Best Pract Res Clin Endocrinol Metab. 2009;23(2):167-79.

Salvatori R. Adrenal insufficiency. JAMA. 2005;294:2481-2488.

Ten S, New M, Maclaren N. Clinical Review 130: Addison's disease. J Clin Endo Metabol. 2001;86:2909-2922.

Thomas Z, Fraser GL. An update on the diagnosis of adrenal insufficiency and the use of corticotherapy in critical illness. Ann Pharmather. 2007;41:1456-65.

Wallace I, Cunningham S, Lindsay J. The diagnosis and investigation of adrenal insufficiency in adults. Ann Clin Biochem. 2009;46(Pt 5):351-367.

Last reviewed November 2012 by Kim Carmichael, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.