Addison’s Disease – Symptoms and Causes
Overview
Addison’s disease, also known as primary adrenal insufficiency, occurs when the adrenal glands produce insufficient amounts of essential hormones.
This includes cortisol and often aldosterone. This rare condition results from damage to the adrenal glands. It can develop gradually with subtle initial symptoms.
Early warning signs of Addison’s disease include:
- Extreme fatigue
- Unusual cravings for salt
- Unintentional weight loss
This condition can affect individuals of any age, gender, or background. Without proper medical intervention, Addison’s disease can become life-threatening. Treatment typically involves hormone replacement therapy. Patients take synthetic hormones to replace those their body cannot produce naturally.
Signs and Symptoms
Addison’s disease typically develops gradually over several months. The slow onset often causes people to dismiss early symptoms. Physical stress from illness or injury can make symptoms worse quickly.
Warning Signs of Adrenal Crisis
An adrenal crisis is a life-threatening emergency that requires immediate medical attention. Call 911 right away if you experience:
- Extreme weakness
- Sudden, severe pain in your lower back, abdomen, or legs
- Severe vomiting or diarrhea
- Severe dehydration
- Fever
- Confusion or reduced awareness
- Fainting or loss of consciousness
- Dangerously low blood pressure
Without immediate treatment, an adrenal crisis can be fatal.
When Medical Care Is Needed
Make an appointment with your doctor if you notice:
- Ongoing fatigue that doesn’t improve with rest
- Muscle weakness that affects daily activities
- Decreased appetite
- Darkened skin patches (may be more noticeable on scars or moles)
- Unexplained weight loss
- Persistent stomach pain or digestive problems
- Dizziness when standing up
- Unusual cravings for salty foods
Early symptoms of Addison’s disease can include:
Physical Symptoms
- Extreme tiredness
- Dizziness when changing positions
- Sweating from low blood sugar
- Stomach upset and digestive problems
- Abdominal pain
- Muscle cramps and general weakness
Appearance Changes
- Loss of body hair
- Darkened skin areas
- Unintentional weight loss
Mental and Emotional Effects
- Depression
- Irritability
- Reduced sex drive (particularly in women)
- Salt cravings
Seek emergency help immediately if you have any signs of an adrenal crisis, especially if you’ve already been diagnosed with Addison’s disease.
Causes
Primary Adrenal Insufficiency
Primary adrenal insufficiency happens when the outer layer (cortex) of the adrenal glands becomes damaged and cannot produce enough hormones. The adrenal glands sit above the kidneys and are vital parts of the endocrine system.
Most cases result from autoimmune disorders where the body’s immune system mistakenly attacks the adrenal glands. People with this condition often have other autoimmune diseases as well.
Other causes include:
- Infections: Tuberculosis can severely damage the adrenal glands. Other infections may also harm these glands.
- Cancer: Cancer spreading to the adrenal glands can impair their function.
- Internal bleeding: Bleeding into the adrenal glands can damage them.
- Genetic conditions: Some people are born with conditions like congenital adrenal hyperplasia that affect these glands.
Medications that can trigger this condition include:
- Certain antifungals like ketoconazole
- Cancer treatments such as mitotane
- Some anesthetics like etomidate
- Medications that block glucocorticoid action
- Cancer therapies called checkpoint inhibitors
The adrenal cortex produces three important types of hormones:
| Hormone Type | Function |
|---|---|
| Glucocorticoids (like cortisol) | Help convert food to energy, support immune function, manage stress response |
| Mineralocorticoids (like aldosterone) | Balance sodium and potassium levels, regulate blood pressure |
| Androgens | Support sexual development, muscle mass, body hair growth, and overall well-being |
When these hormones aren’t produced in sufficient amounts, the body cannot function properly.
Secondary Adrenal Insufficiency
Secondary adrenal insufficiency occurs when the pituitary gland (located near the brain) fails to signal the adrenal glands properly. The pituitary normally makes adrenocorticotropic hormone (ACTH), which tells the adrenal glands to produce cortisol and other hormones.
This condition shares many symptoms with primary adrenal insufficiency but has key differences. People with secondary adrenal insufficiency:
- Don’t develop darkened skin
- Are less likely to experience severe dehydration or low blood pressure
- Have a higher risk of low blood sugar
Several factors can cause the pituitary to produce insufficient ACTH:
- Pituitary tumors (non-cancerous)
- Medical treatments affecting the pituitary, such as:
- Surgery
- Radiation therapy
- Brain injuries that damage the pituitary
Another common cause is the abrupt discontinuation of corticosteroid medications.
These drugs are prescribed for conditions like asthma and arthritis. When stopped suddenly instead of gradually reducing the dose, the body may develop secondary adrenal insufficiency because the adrenal glands haven’t had time to resume normal function.
While primary adrenal insufficiency directly damages the adrenal glands, secondary adrenal insufficiency leaves the glands intact but without proper signaling from the pituitary. Both conditions require proper medical management to prevent serious health complications.
Risk Factors
While Addison’s disease often develops without clear causes, certain factors may increase someone’s risk:
Medical History Factors
- Previous disease affecting the pituitary or adrenal glands
- Past surgery on either the pituitary or adrenal glands
- Traumatic brain injury
Genetic Factors
- Inherited gene changes affecting adrenal function
- Congenital adrenal hyperplasia
Related Conditions
- Other autoimmune endocrine disorders like:
- Hypothyroidism
- Type 1 diabetes
Most people who develop adrenal insufficiency don’t have identifiable risk factors. The condition can occur in anyone, though these factors might increase the likelihood.
Complications
Addison’s disease can create serious health risks if left untreated. The most dangerous complication is adrenal crisis, a life-threatening condition that requires immediate medical attention.
Adrenal crisis often occurs when the body experiences stress from:
- Injuries
- Infections
- Illness
During times of physical stress, healthy adrenal glands typically produce two to three times the normal amount of cortisol. However, people with Addison’s disease cannot increase cortisol production to meet these heightened needs.
This inability to respond to stress leads to several dangerous effects:
- Low blood pressure
- Decreased blood sugar levels
- Elevated potassium in the blood
Without prompt treatment, adrenal crisis can become life-threatening. People with Addison’s disease must be vigilant about monitoring their symptoms and seeking medical care when necessary.
Prevention
While Addison’s disease cannot be prevented, certain steps can help reduce the risk of adrenal crisis, a serious complication.
If you experience persistent fatigue, weakness, or unexplained weight loss, consult with your healthcare professional. These symptoms might warrant testing for adrenal insufficiency.
For those diagnosed with Addison’s disease, proper education is essential. Learn how to:
- Adjust medication doses during illness
- Administer injectable medicine when necessary
- Recognize signs of adrenal crisis
Important: Seek emergency medical care immediately if you become severely ill. This is especially important if vomiting prevents you from taking oral medication.
Many patients worry about potential side effects from corticosteroid treatments. However, the doses prescribed for Addison’s disease are replacement doses.
These are much lower than those used to treat inflammatory conditions. These replacement doses simply provide what your body cannot produce naturally.
With proper management and medical supervision, most people with Addison’s disease can lead normal, healthy lives.
