Addison disease
Adrenocortical hypofunction; Chronic adrenocortical insufficiency; Primary adrenal insufficiency; Addison's diseaseAddison disease is a disorder that causes the adrenal glands to not produce enough hormones.
Adrenal glands
The adrenal glands are two small triangle-shaped glands in the upper abdomen. One gland is located on top of each kidney.
Read Article Now Book Mark ArticleCauses
The adrenal glands are small hormone-releasing organs located on top of each kidney. They are made up of an outer portion, called the cortex, and an inner portion, called the medulla.
The cortex produces 3 hormones:
- Glucocorticoid hormones (such as cortisol) maintain sugar (glucose) control, blood pressure, decrease (suppress) immune response, and help the body respond to stress.
Immune response
The immune response is how your body recognizes and defends itself against bacteria, viruses, and substances that appear foreign and harmful....
Read Article Now Book Mark Article - Mineralocorticoid hormones (such as aldosterone) regulate sodium, water and potassium balance.
- Sex hormones, androgens (male) and estrogens (female), affect sexual development and sex drive.
Addison disease results from damage to the adrenal cortex. The damage causes the cortex to produce hormone levels that are too low.
This damage may be caused by the following:
- The immune system mistakenly attacking the adrenal glands (autoimmune disease)
Autoimmune disease
An autoimmune disorder occurs when the body's immune system attacks and destroys healthy body tissue by mistake. There are more than 80 autoimmune d...
Read Article Now Book Mark Article - Infections such as tuberculosis, HIV, or fungal infections
Tuberculosis
Pulmonary tuberculosis (TB) is a contagious bacterial infection that involves the lungs. It may spread to other organs.
Read Article Now Book Mark ArticleHIV
Human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). When a person becomes infected with HIV, the ...
Read Article Now Book Mark Article - Hemorrhage into the adrenal glands
- Tumors
Risk factors for the autoimmune type of Addison disease include other autoimmune diseases:
- Swelling (inflammation) of the thyroid gland that often results in reduced thyroid function (chronic thyroiditis)
Chronic thyroiditis
Chronic thyroiditis is caused by a reaction of the immune system against the thyroid gland. It often results in reduced thyroid function (hypothyroi...
Read Article Now Book Mark Article - Thyroid gland produces too much thyroid hormone (overactive thyroid, Graves disease)
Overactive thyroid
Hyperthyroidism is a condition in which the thyroid gland makes too much thyroid hormone. The condition is often called overactive thyroid.
Read Article Now Book Mark ArticleGraves disease
Graves disease is an autoimmune disorder that leads to an overactive thyroid gland (hyperthyroidism). An autoimmune disorder is a condition that occ...
Read Article Now Book Mark Article - Itchy rash with bumps and blisters (dermatitis herpetiformis)
Dermatitis herpetiformis
Dermatitis herpetiformis (DH) is a very itchy rash consisting of bumps and blisters. The rash is chronic (long-term).
Read Article Now Book Mark Article - Parathyroid glands in the neck do not produce enough parathyroid hormone (hypoparathyroidism)
Hypoparathyroidism
Hypoparathyroidism is a disorder in which the parathyroid glands in the neck do not produce enough parathyroid hormone (PTH).
Read Article Now Book Mark Article - Pituitary gland does not produce normal amounts of some or all of its hormones (hypopituitarism)
Hypopituitarism
Hypopituitarism is a condition in which the pituitary gland does not produce normal amounts of some or all of its hormones.
Read Article Now Book Mark Article - Autoimmune disorder that affects the nerves and the muscles they control (myasthenia gravis)
Myasthenia gravis
Myasthenia gravis is a neuromuscular disorder. Neuromuscular disorders involve the muscles and the nerves that control them.
Read Article Now Book Mark Article - Body does not have enough healthy red blood cells (pernicious anemia)
Pernicious anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. There are man...
Read Article Now Book Mark Article - Testicles cannot produce sperm or male hormones (testicular failure)
Testicular failure
Testicular failure occurs when the testicles cannot produce sperm or male hormones, such as testosterone.
Read Article Now Book Mark Article -
Type I diabetes
Type I diabetes
Type 1 diabetes is a lifelong (chronic) disease in which there is a high level of sugar (glucose) in the blood.
Read Article Now Book Mark Article - Loss of brown color (pigment) from areas of the skin (vitiligo)
Vitiligo
Vitiligo is a skin condition in which there is a loss of color (pigment) from areas of skin. This results in uneven white patches that have no pigme...
Read Article Now Book Mark Article
Certain rare genetic defects may also cause adrenal insufficiency.
Symptoms
Symptoms of Addison disease may include any of the following:
- Abdominal pain
- Chronic diarrhea, nausea, and vomiting
- Darkening of the skin
-
Dehydration
Dehydration
Dehydration occurs when your body does not have as much water and fluids as it needs. Dehydration can be mild, moderate, or severe, based on how much...
Read Article Now Book Mark Article - Dizziness when standing up
- Low-grade fever
- Low blood sugar
- Low blood pressure, especially with a change in body position
- Extreme weakness, fatigue, and slow, sluggish movement
Fatigue
Fatigue is a feeling of weariness, tiredness, or lack of energy.
Read Article Now Book Mark Article -
Darker skin on the inside of the cheeks and lips (buccal mucosa)
Mucosa
Mucosa is moist tissue that lines certain parts of the inside of your body. It is in your: NoseMouthLungsDigestive tractUrinary and genital tracts G...
Read Article Now Book Mark Article - Salt craving (eating food with a lot of added salt)
- Weight loss with reduced appetite
Symptoms may not be present all the time. Many people have some or all of these symptoms when they have an infection or other stress on the body. Other times, they have no symptoms.
Exams and Tests
Your health care provider will perform a physical exam and ask about the symptoms.
Blood tests will likely be ordered and may show:
- Increased potassium
Potassium
This test measures the amount of potassium in the fluid portion (serum) of the blood. Potassium (K+) helps nerves and muscles communicate. It also ...
Read Article Now Book Mark Article - Low cortisol level
Cortisol level
The cortisol blood test measures the level of cortisol in the blood. Cortisol is a steroid (glucocorticoid or corticosteroid) hormone produced by th...
Read Article Now Book Mark Article - Low sodium level
Sodium level
The sodium blood test measures the concentration of sodium in the blood. Sodium can also be measured using a urine test.
Read Article Now Book Mark Article - Low pH
- Normal testosterone and estrogen levels, but low DHEA level
- High eosinophil count
Eosinophil count
An absolute eosinophil count is a blood test that measures the number of one type of white blood cells called eosinophils. Eosinophils become active...
Read Article Now Book Mark Article
Additional laboratory tests may be ordered.
Other tests may include:
-
Abdominal x-ray
Abdominal x-ray
An abdominal x-ray is an imaging test to look at organs and structures in the abdomen. Organs include the liver, spleen, stomach, and intestines. Wh...
Read Article Now Book Mark Article -
Abdominal CT scan
Abdominal CT scan
An abdominal CT scan is an imaging method. This test uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomog...
Read Article Now Book Mark Article - Cosyntropin (ACTH) stimulation test
Treatment
Treatment with replacement corticosteroids and mineralocorticoids will control the symptoms of this disease. These medicines usually need to be taken for life.
Never skip doses of your medicine for this condition because life-threatening reactions may occur.
Your provider may tell you to increase your dosage for a short time because of:
- Infection
- Injury
- Stress
- Surgery
During an extreme form of adrenal insufficiency, called adrenal crisis, you must inject hydrocortisone right away. Treatment for low blood pressure is usually needed as well.
Adrenal crisis
Acute adrenal crisis is a life-threatening condition that occurs when there is not enough cortisol. This is a hormone produced by the adrenal glands...
Read Article Now Book Mark ArticleSome people with Addison disease (or family members) are taught to give themselves an emergency injection of hydrocortisone during stressful situations. Always carry medical ID (card, bracelet, or necklace) that says you have adrenal insufficiency. The ID should also say the type of medicine and dosage you need in case of an emergency.
Outlook (Prognosis)
With hormone therapy, many people with Addison disease are able to lead a nearly normal life.
Possible Complications
Complications can occur if you take too little or too much adrenal hormone.
When to Contact a Medical Professional
Contact your provider if:
- You are unable to keep your medicine down due to vomiting.
- You have stress such as infection, injury, trauma, or dehydration. You may need to have your medicine adjusted.
- Your weight increases over time.
- Your ankles begin to swell.
- You develop new symptoms.
- While taking treatment, you develop signs of a disorder called Cushing syndrome
Cushing syndrome
Cushing syndrome is a disorder that occurs when your body has a high level of the hormone cortisol.
Read Article Now Book Mark Article
If you have symptoms of adrenal crisis, give yourself an emergency injection of your prescribed medicine. If it is not available, go to the nearest emergency room or call 911 or the local emergency number.
Symptoms of adrenal crisis include:
- Abdominal pain
- Difficulty breathing
- Dizziness or lightheadedness
-
Low blood pressure
Low blood pressure
Low blood pressure occurs when blood pressure is much lower than normal. This means the heart, brain, and other parts of the body may not get enough...
Read Article Now Book Mark Article - Reduced level of consciousness
References
Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(2):364-389. PMID: PMC4880116 www.ncbi.nlm.nih.gov/pmc/articles/PMC4880116/.
Newell-Price JDC, Auchus RJ. The adrenal cortex. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 15.
Nieman LK. Adrenal cortex. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 208.
-
Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
-
Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
Review Date: 5/12/2023
Reviewed By: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.