Locations Main Campus: Chesterfield, MO 63017   |   Locations
314-434-1500 314-434-1500   |   Contact Us

Multimedia Encyclopedia

BACK
TO
TOP
 
E-mail Form
Email Results

 
 
Print-Friendly
Bookmarks
bookmarks-menu

Addison disease

Adrenocortical hypofunction; Chronic adrenocortical insufficiency; Primary adrenal insufficiency

 

Addison disease is a disorder that occurs when the adrenal glands do not produce enough hormones.

Causes

 

The adrenal glands are small hormone-releasing organs located on top of each kidney. They are made up of an outer portion, called the cortex, and an inner portion, called the medulla.

The cortex produces 3 hormones:

  • Glucocorticoid hormones (such as cortisol) maintain sugar (glucose) control, decrease (suppress) immune response , and help the body respond to stress.
  • Mineralocorticoid hormones (such as aldosterone) regulate sodium and potassium balance.
  • Sex hormones, androgens (male) and estrogens (female), affect sexual development and sex drive.

Addison disease results from damage to the adrenal cortex. The damage causes the cortex to produce hormone levels that are too low.

This damage may be caused by the following:

  • The immune system mistakenly attacking the adrenal glands (autoimmune disease)
  • Infections such as tuberculosis , HIV, or fungal infections
  • Hemorrhage into the adrenal glands
  • Tumors

Risk factors for the autoimmune type of Addison disease include other autoimmune diseases :

  • Swelling (inflammation) of the thyroid gland that often results in reduced thyroid function ( chronic thyroiditis )
  • Thyroid gland produces too much thyroid hormone ( overactive thyroid )
  • Itchy rash with bumps and blisters ( dermatitis herpetiformis )
  • Autoimmune disorder that leads to overactivity of the thyroid gland ( Graves disease )
  • Parathyroid glands in the neck do not produce enough parathyroid hormone ( hypoparathyroidism )
  • Pituitary gland does not produce normal amounts of some or all of its hormones ( hypopituitarism )
  • Autoimmune disorder that affects the nerves and the muscles they control ( myasthenia gravis )
  • Body does not have enough healthy red blood cells ( pernicious anemia )
  • Testicles cannot produce sperm or male hormones ( testicular failure )
  • Type I diabetes
  • Loss of brown color (pigment) from areas of the skin ( vitiligo )

Certain rare genetic defects may also cause adrenal insufficiency.

 

Symptoms

 

Symptoms of Addison disease include:

  • Chronic diarrhea, nausea, and vomiting
  • Darkening of the skin in some places
  • Dehydration
  • Dizziness when standing up
  • Paleness
  • Extreme weakness , fatigue , and slow, sluggish movement
  • Mouth lesions on the inside of a cheek (buccal mucosa )
  • Salt craving
  • Weight loss with reduced appetite

 

Exams and Tests

 

Laboratory tests may show:

  • Increased potassium
  • Low blood pressure, especially with a change in body position
  • Low cortisol level
  • Low serum sodium
  • Low blood pH
  • Normal sex hormone levels
  • High eosinophil count in the blood

Additional laboratory tests may be ordered.

Other tests may include:

  • Abdominal x-ray
  • Abdominal CT scan

 

Treatment

 

Treatment with replacement corticosteroids will control the symptoms of this disease. These medicines usually need to be taken for life.

Never skip doses of your medicine for this condition because life-threatening reactions may occur.

Your health care provider may increase your dosage for a short time because of:

  • Infection
  • Injury
  • Stress
  • Surgery

During an extreme form of adrenal insufficiency, called adrenal crisis , you must inject hydrocortisone right away. Treatment for low blood pressure is usually needed as well.

Some people with Addison disease are taught to give themselves an emergency injection of hydrocortisone during stressful situations. Always carry medical ID (card, bracelet, or necklace) that says you have adrenal insufficiency. The ID should also say the type of medicine and dosage you need in case of an emergency.

 

Outlook (Prognosis)

 

With hormone therapy, many people with Addison disease are able to lead a nearly normal life.

 

Possible Complications

 

Complications can occur if you take too little or too much adrenal hormone.

Complications also may result from the following related illnesses:

  • Diabetes
  • Chronic thyroiditis
  • Hypoparathyroidism
  • Ovarian hypofunction or testicular failure
  • Pernicious anemia
  • Overactive thyroid

 

When to Contact a Medical Professional

 

Call your provider if:

  • You are unable to keep your medicine down due to vomiting.
  • You have stress such as infection, injury, trauma, or dehydration. You may need to have your medicine adjusted.
  • Your weight increases over time.
  • Your ankles begin to swell.
  • You develop new symptoms.
  • On treatment, you develop signs of a disorder called Cushing syndrome

If you have symptoms of adrenal crisis, give yourself an emergency injection of your prescribed medicine. If it is not available, go to the nearest emergency room or call 911.

Symptoms of adrenal crisis include:

  • Abdominal pain
  • Difficulty breathing
  • Dizziness or lightheadedness
  • Low blood pressure
  • Reduced level of consciousness

 

 

Open References

References

Barthel A, Willenberg HS, Gruber M, Bornstein SR. Adrenal insufficiency. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 102.

Napier C, Pearce SH. Current and emerging therapies for Addison's disease. Curr Opin Endocrinol Diabetes Obes . 2014;21(3):147-153. PMID: 24755997 www.ncbi.nlm.nih.gov/pubmed/24755997 .

Nieman LK. Adrenal cortex. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 227.

 
  • Endocrine glands

    Endocrine glands - illustration

    Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

    Endocrine glands

    illustration

    • Endocrine glands

      Endocrine glands - illustration

      Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Addison disease

           
             

            Review Date: 10/28/2015

            Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

             
             
             

             

             

            A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.



            Content is best viewed in IE9 or above, Firefox and Google Chrome browser.