Addison disease is a disorder that occurs when the adrenal glands do not produce enough hormones.
Adrenocortical hypofunction; Chronic adrenocortical insufficiency; Primary adrenal insufficiency
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:
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:
Risk factors for the autoimmune type of Addison disease include other autoimmune diseases:
Certain rare genetic defects may also cause adrenal insufficiency.
Symptoms of Addison disease may include any of the following:
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
The health care provider will perform a physical exam and ask about the symptoms.
Blood tests will likely be ordered and may show:
Additional laboratory tests may be ordered.
Other tests may include:
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:
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.
Some people with Addison disease 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.
With hormone therapy, many people with Addison disease are able to lead a nearly normal life.
Complications can occur if you take too little or too much adrenal hormone.
When to Contact a Medical Professional
Call your provider if:
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.
Symptoms of adrenal crisis include:
Barthel A, Benker G, Berens K, et al. An update on Addison's disease. Exp Clin Endocrinol Diabetes. 2019;127(2-03):165-175. PMID: 30562824 www.ncbi.nlm.nih.gov/pubmed/30562824.
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.
Nieman LK. Adrenal cortex. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 227.
Review Date: 5/6/2019
Reviewed By: Brent Wisse, MD, board certified in Metabolism/Endocrinology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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