Addison's Disease

People who have Addison’s disease may experience the following symptoms:

• muscle weakness
• fatigue and tiredness
• darkening in skin color
• weight loss or decreased appetite
• a decrease in heart rate or blood pressure
• low blood sugar levels
• fainting spells
• sores in the mouth
• cravings for salt
• nausea
• vomiting

People living with Addison’s disease may also experience neuropsychiatric symptoms, such as:

• irritability or depression
• lack of energy
• sleep disturbances

If Addison’s disease goes untreated for too long, it can become an Addisonian crisis, also known as an adrenal crisis. Symptoms associated with an Addisonian crisis can include:

• agitation
• delirium
• visual and auditory hallucinations

An Addisonian crisis is a life-threatening medical emergency. Call 911 immediately if you or someone you know begins to experience:

• mental status changes, such as confusion, fear, or restlessness
• loss of consciousness
• high fever
• sudden pain in the lower back, belly, or legs

An untreated Addisonian crisis can lead to shock and death.

There are three major classifications for Addison’s disease: primary, secondary, and tertiary adrenal insufficiency. In order to treat the disease, your doctor will need to find out which type is responsible for your condition.

Primary adrenal insufficiency

Primary adrenal insufficiency occurs when your adrenal glands are damaged so severely that they can no longer produce hormones. This type of Addison’s disease is most often caused when your immune system attacks your adrenal glands. This is called an autoimmune disease.

In an autoimmune disease, your body’s immune system mistakes any organ or area of the body for a virus, bacteria, or another outside invader.

Other causes of primary adrenal insufficiency include:

• prolonged administration of glucocorticoids (also known as steroids, e.g. prednisone)
• infections in your body
• cancer and abnormal growths (tumors)
• certain blood thinners used to control clotting in the blood

Secondary adrenal insufficiency

Secondary adrenal insufficiency occurs when the pituitary gland (located in your brain) can’t produce adrenocorticotropic hormone (ACTH). ACTH tells the adrenal glands when to release hormones.

It’s also possible to develop adrenal insufficiency if you do not take the corticosteroid medications your doctor prescribes. Corticosteroids help control chronic health conditions like asthma.

There are also many other causes of secondary adrenal insufficiency, including:

• tumors
• medications
• genetics
• traumatic brain injury

Tertiary adrenal insufficiency

Tertiary adrenal insufficiency originates in the hypothalamus, a region of the brain near the pituitary gland. The hypothalamus normally sends corticotropin-releasing hormone (CRH) to the pituitary, stimulating it to produce ACTH.

When the hypothalamus fails to produce sufficient CRH, the pituitary fails in turn to produce enough hormones to stimulate the adrenal glands.

Tertiary adrenal insufficiency is most often caused by suddenly stopping corticosteroids after long time use. If you are using these medications, be sure to follow the prescribed medication regimen and to avoid stopping your dosage without discussing the plan with your doctor.

You may be at a higher risk for Addison’s disease if you:

• have cancer
• take anticoagulants (blood thinners)
• have chronic infections like tuberculosis
• had surgery to remove any part of your adrenal gland
• have an autoimmune disease, like type 1 diabetes or Graves’ disease

Your doctor will ask you about your medical history and the symptoms you’ve been experiencing. They will do a physical examination, and they may order some lab tests to check your potassium and sodium levels.

Your doctor may also order imaging tests and measure your hormone levels.

Your treatment will depend on what’s causing your condition. Your doctor may prescribe medications that regulate your adrenal glands.

Following the treatment plan that your doctor creates for you is very important. Untreated Addison’s disease can lead to an Addisonian crisis.

If your condition has gone untreated for too long, and has progressed to a life-threatening condition called Addisonian crisis, your physician may prescribe medication to treat that first.

Addisonian crisis causes low blood pressure, high potassium in the blood, and low blood sugar levels.

Medications

You may need to take a combination of glucocorticoid medications (drugs that stop inflammation) to improve your health. These medications will be taken for the rest of your life and you cannot miss a dose.

Hormone replacements may be prescribed to replace hormones that your adrenal glands are not making.

Home care

Keep an emergency kit that contains your medications on hand at all times. A doctor may prescribe an injectable corticosteroid for emergencies.

You may also want to keep a medical alert card in your wallet and a bracelet on your wrist to let others know about your condition.

Alternative therapies

It’s important to keep your stress level down if you Addison’s disease. Major life events, such as a death of a loved one or an injury, can raise your stress level and affect the way you respond to your medications. Talk to your doctor about alternative ways to relieve stress, such as yoga and meditation.

Diet

Your diet plays an important role in managing the symptoms of Addison’s disease. A high-sodium diet can be beneficial for those with insufficient aldosterone levels. Consult with a healthcare professional or dietitian to find out the right amount of sodium to add to your diet.

Other recommendations include staying hydrated, avoiding processed foods, and increasing your glucose intake.

Some people on a long term steroid regimen may need extra calcium and vitamin D supplementation to counter the risk for osteoporosis.

Grapefruit or high-fiber foods can interfere with corticosteroids and other medications that are used to treat the symptoms of Addison’s, and should be avoided. High caffeine beverages may also worsen your symptoms.

Addison’s disease requires lifelong treatment. Treatments, such as hormone replacement medications, can help you manage your symptoms.

Following the treatment plan your doctor creates is an important step in helping you live a productive life.

Remember, always take your medications exactly as directed. Taking too little or too much medication can negatively affect your health.

Your treatment plan may need to be reevaluated and changed depending on your condition. For this reason, it’s important that you see your doctor regularly.