Cortisol affects almost every organ in the body and is needed for your body to work as it should. The adrenal glands release cortisol to help the body cope with stress from illness, injury, surgery, childbirth, or other reasons. Aldosterone helps the body hold on to the salt it needs, and it keeps your blood pressure steady.
Normally, cortisol levels increase through a chain reaction of hormones:
When your adrenal gland cannot make enough cortisol, you have Addison’s disease.
Addison's disease most often occurs when the body's immune system kills off the part of the adrenal glands that makes cortisol and aldosterone. It can also form when the adrenal glands are harmed by:
People can get Addison's disease at any age. Addison’s disease can also form if you take a steroid medicine for a long time and then suddenly stop using it.
The most common symptoms are:
You may also have other symptoms, such as:
And if you have diabetes, you may have low blood sugar more often, and it may be more severe than usual.
Symptoms usually start slowly. You may not even notice them until a stressful event such as a severe infection, trauma, surgery, or dehydration causes an adrenal crisis. An adrenal crisis means that your body can't make enough cortisol to cope with the stress.
In a few cases, Addison's disease gets worse quickly. These people may already be in an adrenal crisis when they see a doctor.
Symptoms of an adrenal crisis include:
Call your doctor right away if you have these symptoms. If an adrenal crisis is not treated, you could die of shock from a steep drop in blood pressure.
To diagnose Addison’s disease, the doctor will:
If the diagnosis is still not clear, you may have an ACTH stimulation test, which helps show how your hormone levels react to stress. You will be given a man-made form of ACTH to see if your body makes enough cortisol. Further tests will show if you have Addison’s disease or another problem.
Your doctor may suggest some imaging tests, such as an MRI, after the problem area has been found.
If your doctor thinks you have Addison’s disease, he or she may start treatment right away, even before you get your test results. If the test results later show that you don't have the disease, your doctor can stop the treatment.
If you have Addison's disease, you will need to take medicine for the rest of your life to replace the cortisol and aldosterone your body can't make on its own. You may take just one medicine, or you may need more than one. You may need to increase your dose during times of stress or illness. And you may need to add extra salt to your food during hot and humid weather to replace salt lost in your sweat.
If you have an adrenal crisis, you will need treatment in a hospital.
Finding out that you have Addison’s disease can be scary. But if you get treatment and follow your doctor’s advice, you can lead a long and healthy life. Here are some things you can do at home to help you manage the disease:
Frequently Asked Questions
Learning about Addison's disease:
Addison's disease develops when the adrenal glands, located above the kidneys, are not able to produce enough of the hormones cortisol and aldosterone. In most cases, the adrenal glands fail slowly and symptoms begin gradually. But symptoms may appear rapidly if the adrenal glands are destroyed suddenly, such as from trauma or severe bleeding (hemorrhage). The most obvious and common symptoms of Addison's disease include:
Other symptoms include:
Because symptoms develop slowly, they often are not obvious until an adrenal crisis (Addisonian crisis) occurs. An adrenal crisis is caused by a stressful event, such as a severe infection, trauma, surgery, or dehydration. The body is not able to produce enough cortisol to cope with stress. If an adrenal crisis is not treated, you may die from shock caused by a serious drop in blood pressure. Symptoms of an adrenal crisis include:
A wide range of illnesses—many of them not serious—can have symptoms similar to those of Addison's disease, although they are usually not as severe. Other conditions with similar symptoms range from diarrhea and other gastrointestinal problems to more serious illnesses such as hepatitis or cancer.
Addison's disease develops when the adrenal glands, located above the kidneys, are not able to produce enough of the hormones cortisol and aldosterone. Your doctor may suspect Addison's disease from your medical history and physical examination and when blood tests show high potassium, low sodium, and high levels of certain types of white blood cells.
If your doctor suspects Addison's disease, you will have a blood test to determine your cortisol level.
Low blood cortisol levels do not always indicate Addison's disease. During a full day, cortisol levels are highest in the morning, drop during the afternoon, and are lowest overnight. Cortisol levels that are normal at one time of the day may be low at other times of the day. But the level of cortisol should be high when the body is physically or emotionally stressed. The diagnosis of Addison's disease is usually confirmed by doing an ACTH stimulation test, which helps show how your hormone levels react to stress. If your test results show you have high cortisol levels when checked at random or after the ACTH stimulation test, then you do not have adrenocortical disease.
If Addison's disease is diagnosed, your doctor will also look for thyroid problems, such as hyperthyroidism, hypothyroidism, and low production of parathyroid hormone, which causes a low calcium level in the blood. Your doctor will also look for other problems such as type 2 diabetes, pernicious anemia, and failure of the reproductive glands (testes and ovaries). One or more of these conditions are present in about one-half of those with Addison's disease. It is especially important for people with Addison's disease to know if they also have thyroid disease. In people with low thyroid, cortisol lasts longer in the blood. Correcting a low level of thyroid hormone can lead to low cortisol levels and an adrenal crisis.
You may need to see an endocrinologist if the diagnosis or treatment of Addison's disease is uncertain.
Addison's disease develops when the adrenal glands, located above the kidneys, are not able to produce enough of the hormones cortisol and aldosterone. Treatment is usually lifelong. After proper treatment is started, most people with Addison's disease can lead healthy lives.
During a stressful event, such as a severe infection, trauma, surgery, childbirth, dehydration, or an emotional event such as the death of a loved one, you could develop an adrenal crisis. Your body is not able to produce enough cortisol for the stressful condition. If an adrenal crisis is not treated, you may die from shock caused by a serious drop in blood pressure. You would need treatment in the hospital.
Recent small studies suggest that women with Addison's disease may benefit from taking a hormone replacement called dehydroepiandrosterone (DHEA). Some women who take this medicine every day may experience a greater sense of well-being and improvement in depression, anxiety, sexuality, and sensitivity to insulin.1 If you are considering DHEA, talk to your doctor.
Addison's disease develops when the adrenal glands, located above the kidneys, are not able to produce enough of the hormones cortisol and aldosterone. Home treatment is very important. If you have Addison's disease:
In addition, you need to be prepared for and deal with minor illness or stress. During illness or stress, you may need to:
|Canadian Addison Society|
|193 Elgin Avenue West|
|Goderich, ON N7A 2E7|
The Canadian Addison Society (CAS) provides basic information about Addison's disease and related conditions, resources for people who have AD and their families, and links to local chapters. The CAS also publishes a quarterly newsletter.
|U.S. National Adrenal Disease Foundation|
|505 Northern Boulevard|
|Great Neck, NY 11021|
The U.S. National Adrenal Diseases Foundation is a consumer-based organization providing information and support for people with adrenal-related diseases.
- Alkatib AA, et al. (2009). A systematic review and meta-analysis of randomized placebo-controlled trials of DHEA treatment effects on quality of life in women with adrenal insufficiency. Journal of Clinical Endocrinology and Metabolism, 94(10): 3676–3681.
Other Works Consulted
- Aron DC, et al. (2007). Glucocorticoids and adrenal androgens. In DG Gardner, D Shobeck, eds., Greenspan's Basic and Clinical Endocrinology, 8th ed., pp. 367–378. New York: McGraw-Hill.
- Loriaux DL (2009). Adrenal. In EG Nabel, ed., ACP Medicine, section 3, chap. 4. Hamilton, ON: BC Decker.
- Malchoff C (2009). Adrenal insufficiency. In RE Rakel, ET Bope, eds., Conn's Current Therapy 2009, pp. 637–640. Philadelphia: Saunders Elsevier.
- Miller M (2007). Selected endocrine problems. In LR Barker et al., eds., Principles of Ambulatory Medicine, 7th ed., pp. 1367–1394. Philadelphia: Lippincott Williams and Wilkins.
- Stewart PM (2008). Glucocorticoid deficiency section of The adrenal cortex. In HM Kronenberg et al., eds., Williams Textbook of Endocrinology, 11th ed., pp. 445–485. Philadelphia: Saunders.
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||David C.W. Lau, MD, PhD, FRCPC - Endocrinology|
|Last Revised||April 15, 2010|
Last Revised: April 15, 2012
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