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Addison’s disease is a chronic (long-term) condition where your adrenal glands (two small glands located on top of your kidneys) don’t produce sufficient amounts of the hormones cortisol and aldosterone. Cortisol helps your body respond to stress and aldosterone regulates your sodium and potassium levels and controls your blood pressure.
The condition is also known as primary adrenal insufficiency or hypoadrenalism. Addison’s disease is rare and affects around 8,400 people in the UK. It can affect people of any age but is more common in people aged between 30 and 50, and is more common in women than men. Though there is currently no cure for Addison’s disease, the condition can be treated with lifelong medication.
Other types of adrenal insufficiency include:
- Secondary adrenal insufficiency: Occurs when your pituitary gland doesn't produce enough of the hormone adrenocorticotropic hormone (ACTH), which stimulates your adrenal glands to produce cortisol
- Tertiary adrenal insufficiency: Where your hypothalamus doesn't produce enough of the hormone corticotropin-releasing hormone (CRH) that your pituitary gland needs to produce ACTH
This page explains what Addison’s disease is, looks at the causes and symptoms of Addison’s disease, and how the condition is treated.
Addison’s disease usually develops slowly as the damage to your adrenal glands gradually worsens. Symptoms are often vague in the early stages and may resemble other conditions such as depression or a virus like the flu. Symptoms of Addison’s disease vary from person to person but may include:
- Chronic, worsening fatigue: This is usually the main symptom
- Abdominal pain
- Nausea and vomiting
- Diarrhoea
- Hyperpigmentation: Patches of darker skin may appear especially in skin creases, around scars, on areas of your skin exposed to sunlight and on your lips or gums
- Loss of appetite
- Unintentional weight loss
- Muscle weakness, pain, or cramps
- Joint pain
- Dizziness or light-headedness due to low blood pressure
- Increased thirst due to dehydration
- Mood changes such as depression and irritability
- Difficulty concentrating
- Craving salty food
- Low blood sugar (hypoglycaemia)
- Abnormal periods, low libido and loss of body hair (in women)
Addisonian crisis
Addisonian crisis is a medical emergency caused by a sudden, severe drop in cortisol, one of the hormones produced by your adrenal glands. It is also known as acute adrenal failure or an adrenal crisis. Addisonian crisis can occur in response to acute stress such as a traumatic or stressful life event, illness or surgery, or as a result of suddenly stopping or reducing your medication.
Symptoms of Addisonian crisis can come on quickly and may include severe fatigue, dizziness, weakness, sudden, severe abdominal or back pain, nausea, vomiting, diarrhoea, confusion, low blood pressure and collapse. Addisonian crisis needs immediate medical attention and can be life-threatening if left untreated.
Addison’s disease is most commonly caused by an autoimmune disease and occurs when your immune system attacks its own cells — in the case of Addison’s disease, the outer layer of your adrenal gland known as the adrenal cortex. Your damaged adrenal glands then stop making enough of the steroid hormones cortisol and aldosterone. Autoimmune disease accounts for around 70 to 90% of Addison’s disease cases in the UK.
Other, less common causes of Addison’s disease include:
- Tuberculosis: This is the most common cause of Addison’s disease worldwide, but is now uncommon in the UK
- Repeated infections: Include fungal infections and HIV/AIDS-related infections
- Adrenalectomy: The surgical removal of your adrenal glands
- Cancer: Cancer cells may spread to your adrenal glands from other parts of your body
- Bleeding into your adrenal glands: May occur due to meningitis or severe sepsis (blood poisoning)
- Amyloidosis: A condition where certain proteins build up in your organs, including your adrenal glands, causing damage
- Adrenoleukodystrophy (ALD): A rare, inherited disorder that is most common in young boys
- Cushing’s syndrome: A condition where you have high levels of cortisone in your body. Some treatments for Cushing’s syndrome can lead to Addison’s disease.
The cost of Addison's disease treatment depends on your individual circumstances. At the time of your appointment your consultant will discuss all options with you and ensure all your questions are answered.
Our fixed-price packages include the cost of your surgery and all appropriate aftercare appointments. However, any pre-surgery diagnostic tests and your consultant's outpatient appointment consultation fee are charged separately.
Our flexible payment options help you spread the cost of your payment across a time period that suits you.
At your first consultation, you will be seen by a consultant endocrinologist, a doctor specialising in conditions affecting the endocrine system.
Your consultant will ask you about your symptoms, general health, medical and family history, and any medications you take regularly. They may perform a physical examination, including checking your blood pressure and examining your skin for any darkened or discoloured areas. If your consultant suspects that your symptoms may be caused by Addison’s disease, they will order some tests to confirm or rule out this diagnosis.
These may include:
- Blood tests: To check the levels of cortisol, sodium, potassium, certain antibodies and ACTH in your blood and to test for any underlying health conditions
- Thyroid function tests (TFTs): People with Addison’s disease often have an underactive thyroid (hypothyroidism)
- ACTH stimulation test: This test involves administering synthetic ACTH (synacthen) and measuring your adrenal gland’s response by checking the cortisol level in your blood
- Imaging tests: In some cases, scans such as a CT or MRI scan may be performed to examine your adrenal or pituitary glands
How is Addison’s disease diagnosed?
Addison’s disease is diagnosed using a combination of your symptoms and the results of your tests and scans.
Your first appointment is important as it’s where you’ll meet your consultant, the doctor responsible for your care. Your consultant will take time to get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have. At Circle Health Group, we want you to be as well-informed and comfortable as possible during your treatment, so please discuss any questions or concerns with your consultant during your appointment.
At the end of your appointment, your consultant will provide a diagnosis and create an individualised treatment plan tailored to your needs. They will explain your treatment to you, including how to take your medication, any possible side effects and when you need to return to the clinic for a follow-up appointment.
Most cases of Addison’s disease are caused by a problem with your immune system and cannot be cured. In some cases, such as if your Addison’s disease is caused by tuberculosis, the underlying cause can be treated, but this is uncommon.
Treatment for Addison’s disease involves taking medicine every day to replace the hormones cortisol and aldosterone that your body is lacking.
Medications for Addison’s disease
Addison’s disease is treated with medicines called corticosteroids. These include:
- Hydrocortisone: To replace cortisol
- Fludrocortisone: To replace aldosterone
Hydrocortisone
Hydrocortisone comes in the form of tablets which are normally taken two or three times a day. Less commonly, your consultant may prescribe another steroid medication such as prednisolone or dexamethasone. The dose you need to take varies depending on your body’s needs and will be calculated by your consultant. Your dose may also need to be adjusted at certain times such as during a stressful event, illness, or surgery. Your consultant will advise you on this. You will need to carry a steroid emergency card (for adults), or an adrenal insufficiency card (for children) if you take hydrocortisone tablets for Addison’s disease.
Fludrocortisone
Fludrocortisone tablets are used to replace the hormone aldosterone in people with Addison’s disease. Aldosterone works by telling your kidneys to keep salt in your body. A lack of aldosterone causes your kidneys to lose sodium which can cause low blood pressure and symptoms such as dizziness, light-headedness, fatigue, leg cramps, and back and abdominal pain. You may also crave salty food.
Emergency treatment for Addisonian crisis
In some cases, you, or a family member may need to administer an injection of hydrocortisone if you experience an Addisonian crisis such as after a stressful event, illness, or injury, or if you have vomiting or diarrhoea and cannot keep your tablets down. You’ll be provided with an injection kit when you are diagnosed with Addison’s disease and shown how to use it correctly. Once you have given the hydrocortisone injection, call an ambulance immediately.
Like all medications, corticosteroids can cause side effects in some people.
The type of side effects you experience and your risk of developing them depends on:
- The type of corticosteroid you are taking
- The dose
- Your age
- How long you have been taking corticosteroids for
Your consultant will explain all the possible side effects of your specific medication and answer any questions you have before you start your treatment. Always read the label before taking any medication and contact your consultant or pharmacist if you have any questions. Take your corticosteroid tablets exactly as instructed by your consultant.
If you experience unpleasant side effects, or your side effects are getting worse or not getting better, talk to your consultant. Never stop taking your medication or change the dose without first talking to your consultant.
Potential side effects of corticosteroid tablets include:
- Headaches
- Dizziness
- Weakness
- Acne
- Fatigue
- Nausea
- Diarrhoea
- Increased risk of infection
- Muscle aches
- Muscle weakness
- Hypertension (high blood pressure)
- Thin skin that bruises and tears easily
- Swollen ankles
- Increased appetite and possible weight gain
- Mood changes
- Cushing’s syndrome
- Osteoporosis
- Diabetes
- Eye conditions such as glaucoma and cataracts
- Stomach ulcers
- Mental health disorders including depression, anxiety, confusion, suicidal thoughts and hallucinations
Most people with Addison’s disease live full and active lives and can participate in most normal, day-to-day activities. Living with the condition involves taking lifelong medication, managing bouts of fatigue and avoiding Addisonian crisis as much as possible.
You’ll need to have regular checkups with your consultant, normally every six to 12 months to monitor your health and adjust your medication if needed.
Some tips for managing Addison’s disease include:
- Collect your prescriptions when you need to and always ensure you have spare medication available
- Take your medication as prescribed and never skip or delay a dose
- Carry all medications including your injection kit in your hand luggage when travelling, with a note from your consultant explaining what it is and why you need it
- Keep your friends, family and colleagues informed of your condition and let them know what to do if you experience an Addisonian crisis
- Have access to your hydrocortisone injection kit at all times
- Wear a medical alert bracelet, or necklace to inform people that you have Addison’s disease in a situation where you are unable to tell them (such as a car accident)
At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:
- Flexible appointment times and locations that are convenient for you
- The freedom to choose which hospital and consultant suit your needs
- Personalised, consultant-led treatment plans tailored to your individual needs
- Comfortable and safe private facilities maintained by expert multidisciplinary teams
- Private ensuite rooms as standard
- A range of delicious healthy meals
- Affordable, fixed-price packages with aftercare included
- Flexible payment options to help you spread the cost of your care
If you would like to see a consultant or learn more about Addison’s disease treatment, book your appointment online today or call a member of our team directly on 0808 189 5499.
- Treatment. Addison’s disease NHS
- Treatment for Adrenal Insufficiency & Addison’s disease National Institute of Diabetes and Digestive and Kidney Disease
- How is Addison’s disease treated? NICE CK
- How is the diagnosis of Addison’s disease confirmed? National Institute for Health and Care Excellence (NICE)
