Addison’s Disease

What is Addison’s disease?

Addison’s disease is also called primary adrenal insufficiency. It is a condition where your adrenal glands do not make enough adrenal hormones. These hormones help your body deal with stress, keep blood pressure normal, and balance salt and fluids. They also control how your body uses sugars, fats, and proteins. Addison’s disease can lead to an adrenal crisis (Addisonian crisis) if your adrenal gland becomes badly damaged. This is life-threatening and needs immediate treatment.

What causes Addison’s disease?

• Autoimmune disorders: This is the most common cause of Addison’s disease. A problem with your immune system may make your body attack your adrenal glands.
• Cancer metastasis: Cancer cells from other organs can spread to your adrenal glands and cause damage.
• Genetic conditions: You may have been born with genes that cause damage to your adrenal glands. Ask your healthcare provider for more information about the genetic disorders that may cause the condition.
• Infections: These include fungal infections, tuberculosis, and infections that happen more often if you have a weak immune system. Ask your healthcare provider for information on other infections which may cause the condition.
• Surgery: Surgery done to remove one or both of your adrenal glands may cause Addison’s disease.

What is adrenal insufficiency?

Adrenal insufficiency is a condition that develops when your adrenal glands do not make enough adrenal hormones. Adrenal hormones such as cortisol help your body handle stress, keep blood pressure normal, and balance salt and fluids. They control how his body uses sugars, fats, and proteins. An adrenal crisis may happen if your adrenal hormones become too low. This condition is life-threatening and needs immediate treatment.

What causes adrenal insufficiency?

• Autoimmune disorders: A problem with your immune system may make the body attack the adrenal glands.
• Injury: Injury to your adrenal glands may make them bleed, which can prevent the production of adrenal hormones. Trauma may happen when a mother has trouble giving birth to her child. Ask your healthcare provider for more information about causes of adrenal bleeding.
• Genetic conditions: You may have been born with genes that caused the condition. Your risk of adrenal insufficiency is greater if you have a family member with this type of genetic condition.
• Infections: Your adrenal glands may be damaged by certain infections.
• Medicines: Certain medicines may cause adrenal insufficiency. Long-term treatment with steroid medicines for other conditions commonly causes adrenal insufficiency. This may be temporary or permanent. Ask your healthcare provider if any of the medicines you take can cause adrenal insufficiency.
• Other causes: Surgery, tumors, or radiation therapy may cause damage to your adrenal glands.

What are the signs and symptoms of Addison’s disease?

Signs and symptoms may show up slowly over months or years. You may have any of the following:

• Dizziness, weakness, and tiredness.
• Nausea, vomiting, decreased appetite and weight loss.
• Depression or trouble thinking clearly.
• Muscle, joint and back pain.
• Desire for certain foods such as licorice and salty things.
• Loss of hair or white patches of skin on your body.
• Darkening of certain skin areas such as areas exposed to sun, nipples, genital area and the inside your mouth.

How is Addison’s disease diagnosed?

Your healthcare provider will ask you about your health and medical history. This may include information about what signs and symptoms you have and when they started. You may need any of the following:

• Blood tests: These tests tell your healthcare provider how high or low the levels of hormones are in your blood. Other blood tests may be done to give your healthcare providers more information about your health.
• Chemical stimulation tests: Your blood will be tested first. Then you will be given a shot of chemicals that cause your adrenal glands to make hormones. After several minutes, the hormone levels in your blood are tested again. Ask your healthcare provider for information about this test.
• Urine test: This test measures the amount of adrenal hormones in your urine.

How is Addison’s disease treated?

• Steroid medicine: Steroids are given to balance the steroid hormone levels your adrenal glands naturally make. You may need to take this medicine for the rest of your life. You may need to change how much medicine you take when you are ill or have increased stress. Do not stop taking this medicine without talking to your healthcare provider. You can trigger an adrenal crisis if you stop taking steroids suddenly.

What are the signs and symptoms of adrenal insufficiency in children?

The signs and symptoms of adrenal insufficiency depend on your child’s age.

• Signs and symptoms in newborns or infants:
  • Weakness.
  • Vomiting or feeding problems.
  • Dry skin and lips.

• Signs and symptoms in older children:
  • Stomach pain, muscle weakness, or muscle pains.
  • Tiredness, dizziness, or trouble thinking clearly.
  • Craving salty foods, decrease in appetite or weight loss.
  • Decreased or absent pubic hairs.
  • Skin color changes, especially on sun-exposed areas.

How is adrenal insufficiency diagnosed?

• Blood tests: You may need blood taken for tests. These tests tell your healthcare provider how high or low the levels of hormones are in your blood. Other blood tests may be done to give your healthcare providers more information about your health. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. You may need to have blood drawn more than once.
• Chemical stimulation tests: Your blood will be tested first. Then you will be given a shot of chemicals that cause your adrenal glands to make hormones. After several minutes, your hormone levels in your blood are tested again. Ask your healthcare provider for information about this test.
• EEG: This test is also called an electroencephalogram. Many small pads or metal discs are put on your head. Each has a wire that is hooked to a machine. This machine prints a paper tracing of brain wave activity from different parts of your brain. Healthcare providers look at the tracing to see how your brain is working. With Addison’s disease you may have slow brain waves that are causing some of your symptoms.
• Imaging tests: These tests may be done to see why you have Addison’s disease. They can show cancers, infection, or bleeding of your adrenal glands. Certain tests use a special dye to help pictures show up better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your healthcare provider if you are allergic to shellfish, or have other allergies or medical conditions.
  • Computed tomography scan: This is also called CT scan. An X-ray machine uses a computer to take pictures of your adrenal glands. It may also be used to look at tissues, bones, muscles, and blood vessels. Before taking the pictures, you may be given dye through an intravenous (IV) tube in your vein.
  • Magnetic resonance imaging: This test is also called a MRI. During the MRI, pictures of your adrenal glands are taken. You will need to lie still during the test. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury.
• Urine test: This test measures the amount of adrenal hormones in your urine. Ask your healthcare provider for more information about this test.

How is adrenal insufficiency treated?

Steroid medicine is given to balance the steroid hormone levels your adrenals naturally make. You may need to take this medicine for the rest of your life. You may need to change the amount if you are ill or have increased stress. Ask your healthcare provider when and how much to increase the medicine. Do not stop medicine before you talk to your healthcare provider. You can trigger an adrenal crisis if you stop taking steroids suddenly.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You always feel dizzy when you stand up from a sitting or lying position.
• You hear voices or see something that is not real.
• You have severe pain in your stomach, waist, or back.
• You have very dry skin, dry mouth and tongue, or feel more thirsty than normal.
• Your symptoms become worse, even after you take medicine.

When should I call my healthcare provider?

Call your healthcare provider if:

• You have a fever.
• You have diarrhea or constipation.
• You have nausea, vomiting, or stomach pain.
• You sweat or urinate more than usual.
• You have questions or concerns about your condition, treatment, or care.