(Adrenal Insufficiency; Adrenocortical Hypofunction; Chronic Adrenocortical Insufficiency; Hypoadrenalism)
DefinitionAddison's disease is a rare disorder of the adrenal glands. With Addison's, the adrenal glands do not produce enough of the hormones cortisol and aldosterone.
|Addison's occurs because of damage to the cortex.|
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CausesAddison's disease is the result of gradual damage to the outer layer of the adrenal gland. This damage may be caused by:
- The body's own immune system attacking the gland—known as an autoimmune disease.
- Bleeding within the adrenal glands—related to the use of anticoagulant medications and shock
- Surgical complication
- Conditions that are present at birth or due to genetic factors such as enzyme defects and familial glucocorticoid insufficiency
- Cytomegalovirus (CMV) infection associated with AIDS
- Fungal infections, including:
- Cancer including metastases from:
- Medications such as ketoconazole or etomidate
- Radiation treatment
- Chronic illness, including:
Risk FactorsFactors that increase your chance of getting Addison's disease include:
- Having the following autoimmune diseases:
- Anticoagulant medications
- Abdominal injury
- Family members with autoimmune-caused Addison's disease
- Long-term steroid medication treatment, followed by:
- Severe stress
- Previous surgery on adrenal glands
- Hereditary disorders, such as Prader-Willi syndrome and congenital adrenal hyperplasia
SymptomsSymptoms may include:
- Extreme weakness, fatigue
- Weight loss
- Nausea or vomiting
- Chronic diarrhea
- Muscle weakness or pain
- Darkening of freckles, nipples, scars, skin creases, gums, mouth, nail beds, and vaginal lining
- Emotional changes, especially depression
- Cognitive impairment or confusion
- Craving salty foods
- Abdominal pain
- High or low body temperature
- Severe abdominal, back, or leg pain
- Severe dehydration
- Severe nausea, vomiting, and diarrhea
- Bluish skin color
- Muscle weakness
DiagnosisYou will be asked about your symptoms and medical history. A physical exam will be done.Your bodily fluids may be tested. This can be done with:
- Blood tests
- Urine tests
- ACTH stimulation test
TreatmentSymptoms of Addison's disease can be controlled with medications. These drugs replace the missing hormones. Medication needs to be taken for the rest of your life. They may need to be increased during times of stress.Immediate treatment of adrenal crisis includes:
- Self-injection of dexamethasone
- Hydrocortisone by IV
- Normal saline by IV
MaintenanceRegular blood tests are needed to monitor your response to medication. Wear a medical alert bracelet that states adrenal insufficiency or Addison's disease. This will let others know of your condition if you are unable to communicate.
PreventionThere are no guidelines for preventing Addison's disease. If you think you are at risk, talk to your doctor.
The Adrenoleukodystrophy Foundation
National Adrenal Diseases Foundation
The Canadian Addison Society
Adrenal insufficiency and Addison's disease. National Endocrine and Metabolic Diseases Information Service website. Available at: http://endocrine.niddk.nih.gov/pubs/addison/addison.aspx. Updated May 14, 2014. Accessed June 4, 2014.
Adrenal insufficiency in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 16, 2013. Accessed June 4, 2014.
Arlt W, Allolio B. Adrenal insufficiency. Lancet. 2003;361(9372):1881-1893.
Dorin RI, Qualls CR, Crapo LM. Diagnosis of adrenal insufficiency. Ann Int Med. 2003;138:3:194-214.
Hahner S, Allolio B. Therapeutic management of adrenal insufficiency. Best Pract Res Clin Endocrinol Metab. 2009;23(2):167-79.
Salvatori R. Adrenal insufficiency. JAMA. 2005;294:2481-2488.
Ten S, New M, Maclaren N. Clinical Review 130: Addison's disease. J Clin Endo Metabol. 2001;86:2909-2922.
Thomas Z, Fraser GL. An update on the diagnosis of adrenal insufficiency and the use of corticotherapy in critical illness. Ann Pharmather. 2007;41:1456-65.
Wallace I, Cunningham S, Lindsay J. The diagnosis and investigation of adrenal insufficiency in adults. Ann Clin Biochem. 2009;46(Pt 5):351-367.
- Reviewer: Kim Carmichael, MD
- Review Date: 05/2014
- Update Date: 06/04/2014
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