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Addison's disease
Covenant Metabolic Specialists Health Library
Covenant Metabolic Specialists
Physician Reviewed
Dec 3, 2025
What is Addison’s Disease?
Addison’s disease is a chronic endocrine disorder where the adrenal glands, located just above the kidneys, fail to produce enough cortisol and, in most cases, aldosterone.
Cortisol helps regulate metabolism, immune response, and blood pressure. Aldosterone helps manage sodium and potassium balance, and thus fluid levels.
Without these hormones, the body can’t respond to stress or maintain stability—leading to serious complications if untreated.
Symptoms
Symptoms of Addison’s disease tend to develop gradually, but an “Addisonian crisis” can come on suddenly and is a medical emergency.
Early symptoms include:
Extreme fatigue
Weight loss and decreased appetite
Darkening of the skin (hyperpigmentation), especially around scars, skin folds, or gums
Low blood pressure, especially upon standing
Salt cravings
Low blood sugar (hypoglycemia)
Nausea, diarrhea, or abdominal pain
Muscle or joint pain
Depression or irritability
Body hair loss or sexual dysfunction (in women)
Signs of an Addisonian crisis (seek immediate care):
Sudden, severe pain in lower back, abdomen, or legs
Vomiting and diarrhea
Dehydration
Confusion or loss of consciousness
Low blood pressure leading to shock
High potassium and low sodium levels
Causes
The most common cause of Addison’s disease is autoimmune destruction of the adrenal glands. Other potential causes include:
Autoimmune adrenalitis: Body’s immune system attacks adrenal tissue
Infections: Such as tuberculosis, HIV, or fungal infections
Cancer metastasis: Spread of cancer to the adrenal glands
Genetic disorders: Congenital adrenal hyperplasia
Surgical removal or damage to adrenal glands
Bleeding into the adrenal glands (adrenal hemorrhage)
Risk Factors
You may be at increased risk of Addison’s disease if you:
Have an autoimmune disease (e.g., type 1 diabetes, thyroid disease, vitiligo)
Have a family history of adrenal insufficiency
Have been treated for tuberculosis or cancer
Use blood thinners (which increase risk of adrenal bleeding)
Have had adrenal gland surgery or trauma
Are female (autoimmune Addison’s is more common in women)
Diagnosis
Diagnosis of Addison’s disease typically involves:
Medical history and physical exam: Focus on fatigue, skin changes, and blood pressure
Blood tests:
Cortisol levels (usually low in Addison’s)
ACTH (usually elevated in Addison’s)
Electrolytes (low sodium, high potassium)
Renin and aldosterone levels
ACTH stimulation test: Measures how adrenal glands respond to synthetic ACTH
Imaging: CT scan of adrenal glands may reveal damage, calcification, or shrinkage
Antibody tests: May confirm autoimmune causes
Treatments
Treatment focuses on lifelong hormone replacement therapy and emergency management of adrenal crises.
Daily hormone replacement includes:
Hydrocortisone (or prednisone): replaces cortisol
Fludrocortisone acetate: replaces aldosterone for blood pressure and salt balance
DHEA (optional): May be offered to improve mood and energy, especially in women
During illness or stress:
Higher steroid doses may be needed (stress dosing)
Emergency steroid injection kits may be prescribed
In an adrenal crisis:
IV corticosteroids
IV fluids with dextrose and sodium
Rapid stabilization of blood pressure and electrolytes
Prevention
While Addison’s disease itself may not be preventable, adrenal crises are.
Prevention involves:
Wearing a medical alert bracelet
Keeping a steroid emergency kit on hand
Informing all healthcare providers about your diagnosis
Doubling or tripling steroid doses during illness, surgery, or trauma
Regular follow-ups to adjust medication and monitor symptoms
Our Take
Addison’s disease is often misdiagnosed for years because the early symptoms mimic everyday fatigue, anxiety, or GI issues but for us at Covenant, these are red flags.
Especially in women with other autoimmune conditions or unexplained low blood pressure.
We take this seriously because once diagnosed, Addison’s is completely manageable with the right therapy.
The bigger risk isn’t the disease itself, it’s not knowing you have it until crisis hits.
