Definition

Addison disease happens when the adrenal glands do not make enough of a hormone called cortisol. It helps the body with things like blood pressure, metabolism, and the immune system. Aldosterone hormone levels may also be low.

The disease may be:

• Primary—the adrenal glands cannot make hormones
• Secondary—other hormones that tell the adrenal glands what to do are missing or low

A severe problem from this disease is Addisonian or adrenal crisis. It can be deadly.

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Causes

Primary Addison disease is caused by problems with the outer layer of the adrenal gland. This can happen slowly over time.

Addison disease is most often caused when the immune system attacks the gland. It is not known why this happens.

Harm may also be caused by infections, such as:

• Tuberculosis
• Cytomegalovirus (CMV) infection
• Fungal infections

Less common causes are:

• Some cancers
• Amyloidosis—buildup of certain proteins in tissue
• Bleeding within the glands—may happen because of blood thinning drugs or shock
• Having the glands removed with surgery
• Genetic problems or birth defects that make it hard for the glands to work the right way
• Certain medicines

Secondary Addison disease can be caused by harm to the pituitary gland. This gland sends hormones that control the adrenal gland.

This disease may also happen after long-term corticosteroids are stopped.

Risk Factors

This disease is more common in women.

Other things that may raise the risk are:

• Sepsis—sickness caused by a bloodstream infection
• Acute respiratory distress syndrome
• Pneumonia
• Liver disease

Symptoms

Problems may be:

• Being very tired
• Loss of hunger
• Weight loss
• Nausea and vomiting
• Muscle and joint pain
• Dark freckles on nipples, scars, skin creases, gums, mouth, and nail beds
• Craving salty foods
• Mental health issues, such as depression
• In women:
  • Dry and itchy skin
  • Lack of sex drive

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done.

Blood and urine tests may be done to check hormone levels.

Pictures may be taken. This can be done with:

• MRI scan
• CT scan

Treatment

There is no cure. The goal is to manage symptoms and lower the risk of adrenal crisis.

Medicines will be given to replace missing hormones. The dose may need to be raised during times of stress or sickness, such as surgery, pregnancy, or trauma.

Prevention

There are no known guidelines to lower the risk of this problem.