Addison's Disease

What is Addison's disease?

Addison's disease occurs when the adrenal glands (located above each kidney) do not work normally and do not produce enough hormones. Addison's disease may also be called chronic adrenal insufficiency or hypocortisolism.

How does it occur?

The adrenal glands, located near the top of each kidney, produce several types of hormones, including corticosteroids. These hormones affect a number of body functions, including blood pressure, the levels of minerals such as sodium and potassium in the body, defenses against infection and stress, and sugar levels in the blood.

The adrenal glands may stop producing enough hormones when they are damaged by infection, cancer, or an autoimmune response. The adrenal glands may also stop working if you have been taking corticosteroid medicine on a regular basis and then stop taking it suddenly. Because the adrenal glands are controlled by the pituitary gland, sometimes the adrenal glands stop making hormones if the pituitary gland stops working normally.

What are the symptoms?

Symptoms of Addison's disease may start slowly. They include:

• tiredness
• weakness
• loss of appetite
• weight loss
• dizziness when you stand up after sitting or lying down
• muscle aches
• nausea, sometimes with vomiting
• diarrhea
• patches of darkened skin or unexplained "tanning."

You may not notice your symptoms until your body is stressed by an infection, injury, or surgery. The stress may cause an Addisonian crisis. Without treatment, an Addisonian crisis can be fatal. Signs and symptoms of Addisonian crisis are:

• sharp pain in the lower back, abdomen, or legs
• loss of too much fluid from your body (dehydration)
• low blood pressure
• loss of consciousness.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. You may have the following tests:

• blood tests
• ACTH stimulation test (a test that checks the response of your adrenal glands to a pituitary gland hormone)
• CT scan of the adrenal glands or pituitary gland.

How is it treated?

Addison's disease is treated with replacement hormones. Your healthcare provider will prescribe a corticosteroid such as prednisone. You will need to take prednisone the rest of your life.

If the disease has affected the level of minerals in your body, your healthcare provider may also prescribe fludrocortisone. This medicine will help your body return to a normal balance of the minerals sodium and potassium. You may be able to stop taking fludrocortisone after a while.

How long do the effects last?

Addison's disease is a lifelong condition. With proper treatment, crises may be avoided and you will be able to lead a normal life.

How can I take care of myself?

• Treat minor illnesses with extra salt and fluids. It is very important to avoid becoming dehydrated.
• Carry a cortisol injection kit for emergencies. You might need an emergency shot of cortisol in situations where your body is stressed and needs stress hormones to help it respond properly--for example, if you are in an accident. Get a Medic Alert bracelet that says, "Addison's disease: takes cortisone daily." Wear it at all times in case of accidents. It alerts healthcare workers to your need for careful monitoring and extra cortisol.
• Ask your healthcare provider what shots you need to help prevent infections.
• Keep your regular follow-up appointments with your provider.
• Call your healthcare provider right away if you have fever, vomiting, or diarrhea that lasts more than a couple of days. You may need treatment in an emergency room with IV fluids and hydrocortisone.
• See your provider right away if you have any signs of infection, such as strep throat or bladder infections.

How can I help prevent Addison's disease?

There is no way to prevent Addison's disease.