Topic Overview

What is Addison's disease?

Addison's disease develops when the adrenal glands, which are above the kidneys, are not able to make enough of the hormones cortisol and, sometimes, aldosterone.

Your body needs both of these hormones to work as it should. Cortisol helps the body cope with extreme physical stress from illness, injury, surgery, childbirth, or other reasons. Aldosterone helps the body hold on to the salt it needs, and it keeps your blood pressure steady.

Normally, the level of these hormones increases through a chain reaction. First, the hypothalamus in the brain makes a hormone that the pituitary gland needs to make another hormone called ACTH. ACTH then tells the adrenal glands to make cortisol or aldosterone. But with Addison's disease, the adrenal glands can't make enough of the hormones.

If you have Addison's disease, you need to take medicine for the rest of your life to replace the hormones your body can't make. If you don't treat the disease, an adrenal crisis may occur that can lead to death because of a steep drop in blood pressure.

What causes Addison's disease?

Addison's disease can occur:

• When the body's immune system kills off the part of the adrenal glands that makes cortisol and aldosterone. This is the most common cause.
• When the adrenal glands are harmed by:
  • Infections, such as tuberculosis, HIV, and other bacterial or fungal infections.
  • Cancer that has spread to the adrenal glands. This is mostly seen in lung cancer.
  • Bleeding into the adrenal glands as a side effect of using blood thinners.
  • Some types of surgery or radiation treatments.
  • The use of certain medicines, such as high doses of ketoconazole.
• If you take a steroid medicine for a long time and then suddenly stop using it.

People can get Addison's disease at any age.

What are the symptoms?

The most common symptoms are:

• Extreme tiredness.
• Weakness.
• Losing weight without trying.

You may also have other symptoms, such as:

• Skin that looks darker than normal.
• Loss of appetite.
• Diarrhea.
• Feeling light-headed.
• Feeling sick to your stomach or vomiting.
• Craving salt.

If you have diabetes, you may have low blood sugar more often, and it may be more severe than usual.

Symptoms usually start slowly. You may not even notice them until your body is under extreme stress, such as when a severe infection, trauma, surgery, or dehydration causes an adrenal crisis. An adrenal crisis means that your body can't make enough cortisol to cope with the stress.

In a few cases, Addison's disease gets worse quickly. These people may already be in an adrenal crisis when they see a doctor.

What happens during an adrenal crisis?

During an adrenal crisis, the body can't make enough cortisol to deal with extreme physical stress. This can cause:

• Severe vomiting and diarrhea.
• Sudden pain in the belly, low back, or legs.
• A high fever.
• Feeling very weak or light-headed.
• Feeling restless, confused, or fearful.
• Trouble staying awake.

Call your doctor right away if you have these symptoms. If an adrenal crisis isn't treated, you could die of shock from a steep drop in blood pressure.

How is Addison's disease diagnosed?

To diagnose Addison's disease, the doctor will ask about your health, such as if you have had cancer or have HIV or if you have a family history of Addison's disease. You'll also have a physical examination so the doctor can look for changes in your skin colour, check your blood pressure, and look for signs of dehydration.

Your doctor may also order tests, such as:

• Blood tests to check for high potassium or low sodium levels. Your cortisol and ACTH levels may be checked too.
• ACTH stimulation test to see how your hormone levels react to stress.
• Imaging tests, such as a CT scan or an MRI, to look for damage to the adrenal glands.

How is it treated?

Treatment includes medicine, self-care, and being prepared for when your body is under stress. If your doctor thinks that you have Addison's disease, he or she may start treatment right away, even before you get your test results.

Take your medicine as prescribed. You will need to take medicine for the rest of your life to replace the cortisol and aldosterone your body can't make on its own. You may take just one medicine, or you may need more than one.

Take care of yourself at home. You may need to:

• Get enough salt in your diet, because your body may lose too much. You may need to add extra salt to your food during hot and humid weather or when you are exercising and sweating.
• Weigh yourself regularly, especially if you haven't felt like eating or you have been vomiting.
• Monitor your blood pressure. Let your doctor know if it's high or too low and causing you to feel light-headed.
• Get regular checkups. Your doctor needs to check on your symptoms, blood pressure, and hormone levels.

Be prepared for times when your body is under stress. Here are a few ways you can prepare:

• Have a shot of emergency medicine with you at all times. Know when and how to give the medicine. Have instructions written out, and teach someone else how to give you the medicine in case you can't give it to yourself.
• Wear a medical ID tag (such as a medical alert bracelet). That way, health professionals know to give you a shot of cortisol if you are injured or ill and cannot speak for yourself.
• Work with your doctor to create a plan for what to do when you're sick or when your body is under stress.

Finding out that you have Addison's disease can be scary. But if you get treatment and follow your doctor's advice, you can lead a long and healthy life.