Understanding Addison's Disease: Symptoms, Diagnosis, and Treatment

Medically Reviewed by Stephanie S. Gardner, MD on April 26, 2022
4 min read

Addison's disease results from damage to both adrenal glands, which sit atop your kidneys. Your adrenal glands make cortisol when you're under stress. Addison's disease can happen quickly or come on gradually.

Addison's disease, also known as primary adrenal insufficiency, has symptoms that are vague and non-specific. Addison's disease can be difficult to diagnose, and it often takes years for a diagnosis to be made. Symptoms of Addison's disease include:

  • Chronic fatigue and muscle weakness
  • Loss of appetite, inability to digest food, and weight loss
  • Low blood pressure (hypotension) that falls further when standing; this causes dizziness, sometimes to the point of fainting.
  • Blotchy, dark tanning and freckling of the skin; this is most noticeable on parts of the body exposed to the sun, but also occurs in unexposed areas like the gums. Darkened skin is particularly likely to occur on the forehead, knees, and elbows or along scars, skin folds, and creases (such as on the palms).
  • Low blood sugar, including dangerously low blood sugar (hypoglycemia)
  • Nausea, vomiting, and diarrhea
  • Inability to cope with stress
  • Moodiness, irritability, and depression
  • Intolerance to heat or cold
  • Craving for salty foods

Some of these symptoms may indicate conditions other than Addison's disease.

Because symptoms of Addison's disease progress slowly, they may go unrecognized until a physically stressful event, such as another illness, surgery, or an accident, worsens symptoms quickly. When this happens, it's called an Addisonian crisis. For one in four people with Addison's disease, this is the first time they realize they are ill. An Addisonian crisis is considered a medical emergency because it can be fatal.

Symptoms of an Addisonian crisis include:

  • Shock, when the body does not get enough blood flow
  • Multiple organ failure, including kidneys, if circulation of blood cannot be restored
  • Sudden penetrating pain in the lower back, abdomen, or legs
  • Severe vomiting and diarrhea, followed by dehydration
  • Fever
  • Weakness and fatigue
  • Low blood pressure
  • Loss of consciousness

Results from blood tests that point to Addison's disease include a low sodium or high potassium level, anemia (low iron), or a high level of eosinophils (a kind of white blood cell). Often, it's first found through regular blood tests in a hospital or doctor's office. The doctor will also check for hyperpigmentation, or darkening, of the skin or gums -- a sign of long-term Addison's disease.

The most definitive way to diagnose Addison’s is to measure hormone levels in the blood before and after giving ACTH. ACTH is a hormone in the brain that normally increases cortisol release from the adrenal glands. With Addison's disease, the adrenal glands cannot respond to ACTH stimulation, and cortisol levels remain low. Measuring cortisol and ACTH levels can help determine whether adrenal insufficiency is there, and if so, whether the problem is with the adrenal glands or brain.

An evaluation of Addison's disease can include a CT scan of the adrenal glands to look for infection, cancer, or bleeding in the adrenal glands. A tuberculosis test may also be done, because up to 20% of cases are caused by tuberculosis. But the majority are autoimmune.

Because Addison's disease is caused by a lack of normal hormones produced by the adrenal glands, it can be treated by replacing those hormones. This can be done with once- or twice-daily tablets of hydrocortisone, a steroid hormone. If needed, aldosterone can be replaced with a synthetic steroid, fludrocortisone acetate (Florinef), which is taken orally once a day. These medications would need to be increased during times of stress, infection, surgery, or injury.

Treatment is almost always completely successful. When treated, people with Addison's disease can lead a full, normal life. It is important to carry a medic alert bracelet and emergency ID card at all times. You should also keep a small supply of medicine at work or school. Missing even one dose can be dangerous.

In people who may be having an Addisonian crisis, doctor-prescribed injections of salt, fluids, and glucocorticoid hormones may be given immediately -- even before a diagnosis of Addison's disease is confirmed.