The adrenal glands, in particular, produce insufficient amounts of the hormone cortisol and, in some cases, aldosterone. When the body is under stress (for example, fighting an infection), a cortisol deficiency can cause a life-threatening Addisonian crisis characterised by low blood pressure.

Symptoms are generally non-specific and include fatigue, nausea, skin darkening, and dizziness when standing.

Taking hormones to replace those not produced by the adrenal glands is part of the treatment. Addison disease, also known as hypocortisolism or adrenal insufficiency, is a rare disorder characterised by the destruction of the outer layer of the adrenal glands, which produce hormones and are located just above the kidneys. Addison disease is uncommon because it occurs only when at least 90% of the adrenal cortex is destroyed.

Symptoms of Addison’s Disease

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The adrenal cortex produces a variety of hormones known as corticosteroids, which play important roles in the body's functions such as metabolism, blood pressure, and sodium and potassium levels. Cortisol and aldosterone production is disrupted when the cortex is damaged, resulting in a variety of symptoms such as weakness, darkening of the skin and mucous membranes, poor appetite, weight loss, low blood pressure, gastrointestinal upset, and a craving for salt or salty foods.

Addison disease symptoms worsen over time and eventually (after several months) lead to acute adrenal insufficiency, also known as adrenal crisis. Fever, vomiting, diarrhoea, and a sharp drop in blood pressure are all symptoms of an adrenal crisis. Unless the patient is aggressively treated with an intravenous saline solution and cortisol or other glucocorticoids, he may go into shock and die.

Adrenal crisis can occur in people who have no history of adrenal disease and can be triggered by physical stress, such as trauma or illness. The most common cause of the adrenal crisis is bilateral adrenal haemorrhage, which can occur in newborn infants and adults, particularly those taking anticoagulant medications (e.g., heparin or warfarin).

Addison's Disease Causes

Addison's disease is caused by adrenal gland damage, which results in insufficient cortisol and, in some cases, insufficient aldosterone. The adrenal glands are a component of your endocrine system. They produce hormones, which instruct nearly every organ and tissue in your body.

Tuberculosis (TB) is the most common cause of Addison's disease globally, but it is uncommon in the United Kingdom. Tuberculosis (TB) is a bacterial infection that primarily affects the lungs but can also spread to other parts of the body.

Who is at Risk for Addison’s Disease?

If you have cancer or use anticoagulants, you may be at a higher risk for Addison's disease (blood thinners)
have long-term infections such as tuberculosis
had any part of your adrenal gland surgically removed
suffer from an autoimmune disease, such as type 1 diabetes or Graves' disease.

Diagnosing Addison’s Disease

Your doctor will inquire about your medical history as well as the symptoms you've been experiencing. They will perform a physical examination and may order lab tests to determine your potassium and sodium levels.

Your doctor may also order imaging tests and hormone levels measurements.

Addison’s Disease Treatment

Your treatment will be determined by the cause of your condition. Adrenaline-regulatory medications may be prescribed by your doctor.

It is critical that you adhere to the treatment plan that your doctor has devised for you. Addison syndrome, if left untreated, can result in an Addisonian crisis.

If your condition has gone untreated for too long and has progressed to a potentially fatal condition known as Addisonian crisis, your doctor may first prescribe medication to treat that.

Low blood pressure, high potassium levels in the blood, and low blood sugar levels are all symptoms of the Addisonian crisis.

Medications

To improve your health, you may need to take a combination of glucocorticoids (anti-inflammatory drugs). These medications will be taken for the rest of your life, and you will not be able to skip a dose.

Hormone replacement therapy may be recommended to replace hormones that your adrenal glands do not produce.

Home Care

Always keep an emergency kit containing your medications on hand. In an emergency, ask your doctor to write a prescription for an injectable corticosteroid.

You should also carry a medical alert card in your wallet and a bracelet on your wrist to alert others to your condition.

Alternative Therapies

If you have Addison's disease, it is critical that you maintain a low-stress level. Major life events, such as the death of a loved one or an injury, can increase your stress level and influence how you respond to medications. Consult your doctor about stress-relieving activities such as yoga and meditation.

What is Expected in the Long Term?

Addison's disease necessitates lifelong care. Treatments, such as hormone replacement therapy, can assist you in managing your symptoms.

Following your doctor's treatment plan is an important step toward living a productive life.

Always take your medications exactly as prescribed. Taking too little or too much medication can harm your health. Depending on your condition, your treatment plan may need to be reevaluated and modified. As a result, it is critical that you see your doctor on a regular basis.

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FAQs on Addisons Disease and Primary Adrenal Insufficiency

1. What is Addison’s disease?

Addison’s disease is a rare endocrine disorder in which the adrenal cortex does not produce enough cortisol and often aldosterone. It is also called primary adrenal insufficiency. In this condition:

The immune system commonly destroys the adrenal cortex (autoimmune cause).
Low cortisol affects metabolism, stress response, and blood sugar regulation.
Low aldosterone disrupts sodium and potassium balance and blood pressure control.

This hormonal deficiency leads to fatigue, weight loss, and low blood pressure.

2. What causes Addison’s disease?

Addison’s disease is most commonly caused by autoimmune destruction of the adrenal glands. The main causes include:

Autoimmune adrenalitis (most common cause).
Infections such as tuberculosis affecting the adrenal cortex.
Adrenal hemorrhage or metastatic cancer.
Genetic disorders affecting adrenal development.

All these causes damage the adrenal cortex, reducing cortisol and aldosterone production.

3. What are the main symptoms of Addison’s disease?

The main symptoms of Addison’s disease are chronic fatigue, weight loss, and low blood pressure due to low cortisol and aldosterone levels. Common symptoms include:

Severe tiredness and muscle weakness.
Hyperpigmentation (darkening of skin and mucous membranes).
Low blood pressure (hypotension).
Salt craving.
Nausea, vomiting, and abdominal pain.

Symptoms usually develop slowly and may worsen during physical stress or illness.

4. Why does hyperpigmentation occur in Addison’s disease?

Hyperpigmentation in Addison’s disease occurs because low cortisol leads to increased secretion of ACTH (adrenocorticotropic hormone). When cortisol levels drop:

The pituitary gland releases more ACTH to stimulate the adrenal cortex.
ACTH is derived from POMC, which also produces MSH (melanocyte-stimulating hormone).
MSH stimulates melanocytes to produce more melanin.

This excess melanin causes darkening of the skin, especially in skin folds and scars.

5. How is Addison’s disease diagnosed?

Addison’s disease is diagnosed by measuring low cortisol levels and confirming impaired adrenal response to ACTH. Key diagnostic steps include:

Blood test showing low serum cortisol.
High ACTH levels in primary adrenal insufficiency.
ACTH stimulation test showing little or no rise in cortisol.
Electrolyte imbalance such as low sodium and high potassium.

These findings confirm reduced adrenal cortex function.

6. What is an Addisonian crisis?

An Addisonian crisis is a life-threatening acute worsening of adrenal insufficiency due to extremely low cortisol levels. It may be triggered by infection, injury, or stress and is characterized by:

Severe hypotension (very low blood pressure).
Dehydration and shock.
Severe vomiting and abdominal pain.
Low blood glucose (hypoglycemia).

This medical emergency requires immediate treatment with intravenous hydrocortisone and fluids.

7. What is the difference between primary and secondary adrenal insufficiency?

The main difference is that primary adrenal insufficiency involves damage to the adrenal glands, while secondary adrenal insufficiency results from low ACTH production by the pituitary gland. Key differences include:

Primary (Addison’s disease): Low cortisol, low aldosterone, high ACTH, hyperpigmentation present.
Secondary adrenal insufficiency: Low cortisol, normal aldosterone, low ACTH, no hyperpigmentation.

This distinction helps guide diagnosis and treatment.

8. How does Addison’s disease affect electrolyte balance?

Addison’s disease disrupts electrolyte balance by reducing aldosterone, which controls sodium and potassium levels. When aldosterone is low: