Addison's disease

Addison's disease is a chronic disease that occurs when the adrenal glands do not produce enough (or any) of the hormones cortisol and aldosterone.^[1][2] Symptoms can vary from person to person but usually develop slowly over time, and are often non-specific at first.^[2] However, sometimes symptoms occur suddenly and cause a life-threatening condition called acute adrenal failure, also known as an acute adrenal crisis or Addisonian crisis.^[2][3]

Common symptoms of Addison's disease include fatigue, loss of appetite, and abdominal pain and nausea. Some people also experience mood or behavior changes. Other signs and symptoms of Addison's disease that may develop include dark patches of skin (hyperpigmentation), vitiligo, muscle weakness or pain, dehydration, and low blood pressure.^[2][3]

An acute adrenal crisis is a medical emergency which can lead to shock or kidney failure if not treated promptly. A crisis may cause sudden weakness, severe pain (in the back, abdomen, or legs), vomiting and diarrhea, and low blood pressure which can lead to fainting. A crisis may  be triggered when a person with Addison's disease is under stress, such as during an accident, surgery, or severe illness.^[2][3]

In most cases, Addison's disease is caused by damage to the adrenal cortex (the outer part of the adrenal gland) due to an autoimmune reaction. In these cases, a person may not develop symptoms for months or years. This may be referred to as autoimmune Addison's disease, or primary adrenal insufficiency. If the adrenal glands do not produce hormones despite being undamaged (such as due to ACTH deficiency), it is referred to as secondary adrenal insufficiency. Less common causes of Addison's disease include repeated infections, cancer that spreads to the adrenal glands, CMV associated with HIV/AIDS, and amyloidosis. Tuberculosis remains a major cause in developing countries, but is no longer a major cause in the United States. Rarely, Addison’s disease runs in families and may be due to a genetic predisposition.^[2][3]

Addison's disease may be diagnosed based on symptoms, blood and urine tests that evaluate adrenal function, chest X-rays, and/or a CT scan to look at the size and characteristics of the adrenal glands.^[1][2][3] Treatment ideally should  be managed by an endocrinologist who specializes in adrenal diseases. Daily treatment typically includes medicines (tablets) that replace the hormones cortisol and aldosterone. Treatment for an adrenal crisis may include intravenous hydrocortisone, fluids, and electrolytes, as well as drugs that normalize blood pressure.^[2][3] People with Addison's disease should carry a medical ID that states the disease and emergency instructions.^[2][3] An example is provided by the National Adrenal Diseases Foundation. With proper treatment and avoidance of dehydration, people with Addison's disease can avoid having crises and have a normal life expectancy.^[3]

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