Addison’s disease, also known as primary adrenal insufficiency, occurs when the adrenal glands fail to produce enough cortisol or aldosterone. Without these crucial hormones, you might feel fatigued, experience muscle weakness, and lose weight unintentionally.
This condition is quite rare, affecting about one in 100,000 people in the U.S. However, those with Addison’s disease can manage their symptoms and avoid severe complications through hormone therapy.
Symptoms tend to develop slowly and may resemble those of other illnesses, making diagnosis tricky. Fatigue is usually the first sign. Another early symptom is hyperpigmentation, where dark patches show up on scars, skin creases, and mucous membranes like the gums.
Other symptoms might appear sporadically, becoming more noticeable during infections or physical stress. In some cases, symptoms can rapidly worsen, leading to what’s called an addisonian crisis, especially during events like surgery or severe infection. This crisis can be life-threatening, causing kidney failure and severe pain in the lower back, abdomen, or legs.
Addison’s disease generally occurs when the immune system mistakenly harms the adrenal cortex, the outer layer of the adrenal glands located atop the kidneys. This damage prevents the production of adequate cortisol and aldosterone. These hormones are vital for basic bodily functions: cortisol helps regulate blood pressure, blood sugar, metabolism, and inflammation, while aldosterone manages sodium and potassium levels, crucial for muscle and nerve function, blood pressure, and heartbeat.
Though anyone can develop Addison’s disease, it’s more common among women and individuals aged 30 to 50. An existing autoimmune disorder can increase risk.
Initial suspicion of Addison’s often arises from bloodwork showing low sodium or high potassium levels, or from symptoms prompting further investigation. Diagnosis involves assessing symptoms, medical history, and conducting specific tests, including those measuring cortisol levels. Typically, a cortisol level above 18 mcg/dL is normal, while below 3 mcg/dL suggests adrenal insufficiency. An ACTH test might be done to confirm the presence of Addison’s disease.
Treatment involves lifelong steroid hormone therapy to replace the missing hormones. Medications like hydrocortisone and fludrocortisone are typically prescribed. Dosage may require adjustment during periods of stress. If an addisonian crisis occurs, emergency IV treatment with high-dose hydrocortisone and fluids is necessary.
There’s no known way to prevent Addison’s disease, but early treatment can help avoid complications. The condition itself increases the risk for additional autoimmune disorders. It’s critical to take the proper hormone dosage, as incorrect amounts can lead to obesity, diabetes, and osteoporosis.
To manage Addison’s disease, it’s important to consistently follow prescribed medication regimens and work closely with healthcare providers. Wearing a medical alert bracelet and possibly modifying your diet, like adopting a high-sodium intake if necessary, are also recommended. Adequate calcium and vitamin D consumption may be advised to prevent osteoporosis due to high-dose corticosteroid use. With careful management, those with Addison’s disease can lead a life much like any other.
