This is a condition in which the body does not produce enough hormones. It happens quite rarely and is called Addison’s disease or primary adrenal insufficiency. Therefore, the adrenal glands of people with this condition produce too few hormones (such as Cortisol). Commonly, they also produce decreased levels of another hormone called Aldosterone.
The primary cause of this rare condition is damage to the adrenal glands. While some people experience the symptoms gradually, others may notice that they appear suddenly. For example salt cravings, extreme tiredness, and unusual weight loss.
Primary adrenal insufficiency may happen in anyone, and not treating it may be life-threatening. The most common treatments involve synthetic (lab-made) hormones to replace missing ones.
Symptoms
In most cases, symptoms caused by this condition appear gradually (over months). That’s why people usually ignore the early symptoms of the disease. However, physical stress (such as illnesses or injuries) may worsen Addison’s disease symptoms quite quickly. Check below some early symptoms of primary adrenal insufficiency:
- Loss of energy
- Fatigue (extreme tiredness)
- Dizziness or fainting that happens when you stand after lying down or sitting. This symptom occurs due to a type of low blood pressure called postural hypotension.
- Sweating caused by hypoglycemia (low blood sugar)
- Stomach upset
- Diarrhea
- Vomiting
- Abdominal (belly) pain
- Muscle cramps, weakness, or pain
- Joint pain
- Body hair loss
- Skin areas that become darker (especially on scars or moles)
- Weight loss that occurs often due to appetite changes
However, early symptoms of the disease may negatively affect your mental health, emotions, and desires. These include mood swings, irritability, depression, salt cravings, and reduced sex drive in females.
Adrenal Crisis
In some cases, the symptoms of this condition may worsen quickly. The symptoms listed below are considered a medical emergency, and it is called an adrenal crisis. In such cases, you should go to the nearest emergency room or call 911 in the U.S. or an emergency number from your region. Check below the adrenal crisis symptoms:
- Severe weakness
- Sudden and severe pain in the lower back, legs, or abdomen
- Severe vomiting, diarrhea, and stomach upset
- Dehydration (loss of body fluids)
- Fever
- Confusion
- Loss of consciousness
- Hypotension
Previous symptoms require immediate treatment. Otherwise, it may lead to death.
You should see a doctor if any of the following symptoms occur. These include:
- Extreme tiredness that lasts for long periods
- Muscle weakness
- Appetite changes without any obvious reasons
- Severe vomiting and stomach pain
- Salt cravings
- Lightheadedness with standing
- Unusual weight loss
Causes
In most cases, people experience this condition due to damage to the adrenal glands. The adrenal glands are located above the kidneys and they are an important part of the gland and organ system such as endocrine system, which produces hormones. In normal circumstances, the adrenal glands produce hormones that affect roughly every tissue and organ in the body.
These glands are made of two layers (the inner layer is called the medulla, which produces hormones such as Adrenaline, and the second layer is called the cortex, which produces multiple hormones called corticosteroids). Check below some corticosteroids:
- Glucocorticoids – These hormones affect the body’s ability to turn food into energy and help the body respond to stress. This group of hormones includes Cortisol.
- Mineralocorticoids – This group includes Aldosterone and it helps maintain Sodium and Potassium in the body balances. These salts in the body help keep blood pressure in a healthy range.
- Androgens – Adrenal glands in all people make a small amount of these sex hormones that affect sex drive, body hair, and muscle mass, and play an important role in male sexual development.
In addition, there is a related condition to Addison’s disease (also known as primary adrenal insufficiency) called secondary adrenal insufficiency.
Primary Adrenal Insufficiency
This type of condition occurs when the outer layer of the adrenal glands is damaged, which leads to reduced hormone production. In most cases, people develop Addison’s disease due to antibodies produced by the immune system that mistakenly attack healthy tissues and organs (an autoimmune condition). Check below for other causes of Addison’s disease:
- Serious infections (such as tuberculosis)
- Other adrenal gland infections
- Cancer that spreads to the adrenal glands from another body part
- Genetic disorders present at birth that negatively affect the adrenal glands (also known as congenital adrenal hyperplasia)
- Certain medicines that block the body’s ability to produce glucocorticoids (including Ketoconazole, Mitotane, and Etomidate). However, some medications may block the action of glucocorticoids in the body. For example, Mifepristone.
- Cancer treatments that contain medicines (also called checkpoint inhibitors)
Secondary Adrenal Insufficiency
Generally, the secondary type of the condition has many similar symptoms to Addison’s disease. Moreover, this condition occurs due to different causes compared to the primary type of the disease and it happens more commonly. It often appears when the pituitary gland does not work properly and adrenal glands begin to produce less Cortisol.
In normal circumstances, the pituitary gland produces a hormone (known as adrenocorticotropic hormone or ACTH) that causes the outer layer of the adrenal glands to make hormones (including Androgens and Glucocorticoids). When the pituitary gland makes too little ACTH, it affects levels of hormones produced by the adrenal glands as well.
All symptoms of secondary adrenal insufficiency are similar to the primary type. The only difference is that people with the secondary type will not experience severe dehydration or hypotension, but low blood sugar. Check below some factors that cause the pituitary gland to produce less ACTH:
- Benign (noncancerous) tumors of the pituitary gland
- Brain injury
- Radiation therapy or surgery of the pituitary gland
In addition, sometimes, people may experience secondary adrenal insufficiency for a short period. It often occurs when you suddenly interrupt the use of certain medicines called corticosteroids. Thus, it is not allowed to stop suddenly using these medicines, and you should gradually lower the dose. Corticosteroids are often used to treat arthritis and asthma. Discuss with your healthcare professional about ways to prevent the secondary type of this disease caused by medicines.
Risk Factors
While in most cases, people with primary adrenal insufficiency do not have any risk factors, physicians identified some that could increase the risk of developing it. Check below some examples:
- A disease or surgery that negatively affects the pituitary gland or adrenal glands.
- Certain genetic changes that impact the pituitary or adrenal glands. For example, gene mutations that cause an inherited disease called congenital adrenal hyperplasia.
- Autoimmune endocrine diseases (such as hypothyroidism, type 1 diabetes, and others)
- Traumatic brain injuries
Complications
People with this condition may experience some complications. One of the most serious complications is the adrenal crisis (also known as the Addisonian crisis).
Usually, persistent stress, injury, illnesses, or infections trigger an adrenal crisis. For instance, in response to physical stress, the adrenal glands produce even 2 or 3 times more Cortisol than usual. However, in people with adrenal insufficiency, the glands cannot produce enough hormones to meet the body’s needs, which often results in an adrenal crisis. Therefore, adrenal crisis may cause hypotension (low blood pressure), low blood sugar, or increased Potassium levels in the blood. In addition, an adrenal crisis requires immediate treatment. Otherwise, it may lead to death.
How to Prevent Addison’s Disease?
There are no sure ways to prevent this condition. However, the following steps may help reduce the risk of developing a more severe form of the disease and prevent adrenal crisis. For example:
- Do not hesitate to see a doctor if you continuously feel tired or weak or experience weight loss without any obvious reasons.
- Discuss with your healthcare professional what to do if you have Addison’s disease when you are sick.
- Go to the nearest emergency room if you are very sick or call 911 in the U.S.
In some cases, people are concerned about the adverse reactions that may be caused by corticosteroids. However, doctors often recommend low doses of corticosteroids only to replace the missing hormones. Anyway, never take high doses of these medications without a doctor’s approval because it may lead to severe adverse reactions.
Diagnosis
The diagnosis of this condition involves multiple steps. For example, the first one is a physical examination and questions about the symptoms and your medical history. Thereafter, physicians may perform some tests to check the type of adrenal insufficiency you experience. For example:
- Blood Tests – These tests are used to check Sodium, Potassium, Cortisol, and ACTH levels. A blood test also can be used to check for antibodies associated with Addison’s disease.
- ACTH stimulation test – Generally, ACTH tells the adrenal glands to produce Cortisol. This test is used to measure the Cortisol level in the blood before a shot of synthetic ACTH.
- Insulin-induced hypoglycemia test – This test is often used to determine if the pituitary gland causes secondary adrenal insufficiency. It involves blood sugar and Cortisol measurements after a shot of insulin.
- Imaging tests – The following tests are used to get detailed images of the adrenal glands and nearby tissues and organs. Physicians usually perform an MRI (magnetic resonance imaging) scan to check the adrenal gland size and other abnormalities.
Treatment
The treatment goal is to return hormones that are missing to a normal range. Check some medicines often recommended by doctors for people with Addison’s disease:
- Hydrocortisone, Prednisone, or Methylprednisolone (these medicines are used to replace Cortisol)
- Fludrocortisone acetate to replace Aldosterone
Along with previous medicines, physicians may recommend some dietary changes that include plenty of Sodium and others.
Sometimes, doctors recommend to increase the dose of the medicine. It is needed when you are stressed during surgery or due to an infection or minor illness.
For the life-threatening complication of this disease (adrenal crisis), physicians usually use corticosteroids, saline solution, and sugar to treat it.
Frequently Asked Questions
What is the cause of Addison’s disease?
In most cases, people develop this condition due to an autoimmune condition where the immune system makes antibodies that mistakenly attack the adrenal glands. Other causes include infections, cancer, and bleeding into the adrenal glands.
What does an Addison crisis feel like?
This complication is also known as adrenal crisis or acute adrenal failure. It is considered a medical emergency and causes the following symptoms. For example, sudden and severe pain in the lower back, abdomen, or legs, and severe weakness. Discuss with your doctor for more details.
What is the life expectancy of someone with Addison’s disease?
Generally, people who get treatment for the condition have a normal lifespan. However, people with Addison’s disease need to administer medications for the rest of their lives. Ask your healthcare provider if you have additional questions.
