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Addison's disease

Addison’s disease refers to the dysfunction of the adrenal glands, which are situated above the kidneys. It’s when the glands don’t produce enough vital steroid hormones (cortisol and aldosterone) which can make someone very ill.

  1. Symptoms gradually become more severe
  2. Can be caused by various infections and inherited conditions
  3. Treated with cortisol replacement

Addison’s disease can be difficult to recognise at first, as symptoms may be unclear, and are often associated with other conditions. However, if you are concerned that you may have the condition and would like to speak to a GMC-registered doctor online, you can do so by using our video consultation service. You can consult with a doctor at a time that’s suitable for you.

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Description

What is Addison's disease?

Addison’s disease is a condition where the adrenal glands become damaged, and this adversely affects hormone production. The adrenal glands produce vital hormones, cortisol and aldosterone, which are needed for regulating metabolism, stress levels and blood pressure. 

Addison’s disease is most commonly an autoimmune condition, but it can be caused by a variety of different infections.

What symptoms does Addison's disease cause?

Symptoms of Addison’s disease include weight loss, feelings of fatigue, muscle weakness, feeling thirsty and needing to go to the toilet more often.

It’s thought that at least 70% of cases of Addison’s disease are caused by an autoimmune disorder. Around 60% of these are part of a larger problem called autoimmune polyendocrine syndrome, in which more than one organ is affected by the immune system attacking it. The estimated prevalence across the whole of Europe is between 93 and 144 people per one million of the population. More women are affected than men, and the most common age of onset is between 30 and 50.

Symptoms of Addison’s disease develop gradually over weeks and months. The drop in the level of cortisol can lead to many possible symptoms. Some notable symptoms include a general feeling of weakness, pigmentation in areas of the skin which are sun-exposed or near creases, weight loss, low blood pressure, feeling sick and cramps, and muscle pain. An Addison’s crisis occurs when the level of cortisol falls to such an extent that you become very ill. It can suddenly develop with another illness, during which time the body needs more cortisol, and so having Addison’s disease puts an even greater strain on the adrenal glands.

What complications can Addison's disease lead to?

The most common complication of Addison’s disease is an adrenal crisis. Although preventable, it’s understood to occur in around 8% of people with Addison’s, and can be fatal if not treated properly. The symptoms of Addison’s disease can lead to a general reduction in quality of life, because of their longevity. It’s believed that there is an increased likelihood of premature mortality in people who have Addison’s disease, and lifelong treatment is required.

Is Addison's disease preventable?

Addison’s disease can’t be prevented, but it is important to be aware of other conditions which could potentially trigger the illness. They include type 1 diabetes, cancer and bacterial infections such as tuberculosis. If you have Addison’s disease, you can lower the risk of an Addison’s crisis by ensuring that you have enough medication ready.

The condition is treated with corticosteroid medication, to replace lost hormones. If you have Addison’s disease, you’ll normally need to take this long term.

If you are displaying symptoms of Addison’s disease, and you are concerned about the condition, you should speak to a doctor. The Treated.com live service is available if you wish to speak to one of our GMC-registered clinicians online. They can advise you about whether your symptoms warrant further investigation. If you have already been diagnosed with the condition and are taking treatment, our doctors can renew your prescription for hormone replacement therapy medication.

Page last reviewed:  16/06/2020
Diagnosis and treatment

What are the causes of Addison’s disease?

Addison’s disease is an autoimmune condition, in which the immune system attacks the adrenal glands by mistake, destroying the cells which create cortisol and aldosterone. What triggers this in the body remains unclear. 

Tuberculosis is the second-most common cause, and leads to Addison’s disease if the infection in the lungs spreads to the adrenal glands (rare). Other less common causes include HIV, cancer and rare genetic conditions such as adrenoleukodystrophy.

How is Addison’s disease diagnosed?

Addison’s disease is a difficult condition to diagnose, as its symptoms can be confused with many other conditions. In half the cases of Addison’s disease, signs and symptoms are present for a year before the condition is eventually diagnosed.

General symptoms which a doctor will look out for include fatigue, gastrointestinal symptoms (weight loss, loss of appetite, vomiting), high blood pressure, muscle weakness and headaches.

Will I need tests?

A doctor will need to conduct some tests in order to diagnose Addison’s disease.

For further investigations, a doctor will assess the serum cortisol level in the blood, which is reduced in cases of Addison’s disease. They are likely to also check sodium levels, which are also decreased among those with the condition, and potassium and calcium levels, which are elevated.

How is Addison’s disease managed?

Addison’s disease is managed with a course of cortisol replacement. Hydrocortisone is usually used in 15 to 30 mg doses, which varies depending on the medical profile of the person.

This dose is broken up into two or three doses a day, with a higher dose taken in the morning and a lower dose in the evening. Aldosterone is replaced with fludrocortisone, which helps to regulate blood pressure and salt levels.

It is important to be aware that Addison’s disease is a lifelong condition, which has potentially life-threatening complications if the hormones are not replaced properly at any point. If another illness or injury is sustained, the medication may have to be adjusted. It may also be necessary to show a family member how to administer hydrocortisone, in the event of an adrenal crisis.

Page last reviewed:  16/06/2020
Questions and Answers

How is Addison’s disease treated?

Addison’s disease is treated with hormone replacement therapy. Hydrocortisone is the most common corticosteroid which is prescribed, and it is given in doses between 15 and 30 mg daily. Fludrocortisone is also prescribed for the loss of aldosterone. It is a lifelong course of treatment, and doses may need changing depending on a person’s general health.

How long will it take for me to recover?

Unfortunately, there is no cure for Addison’s disease and it is a lifelong condition. Taking the correct dose consistently will prevent the likelihood of suffering from an adrenal crisis and symptoms becoming worse.

Can I consult a doctor about Addison’s disease online?

You can consult a doctor about symptoms, such as going to the toilet more often, fatigue or weight loss, via the Treated.com live service. You can book an appointment with one of our GMC-registered doctors at a time that’s convenient for you. They can advise you as to whether your symptoms warrant further investigation. If you have already been diagnosed with the condition, our doctors can also renew your prescription for medication.

Page last reviewed:  16/06/2020

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