Addison’s disease

Addison’s disease is a rare disorder of the adrenal glands that occurs when the body does not produce enough of the hormones cortisol and aldosterone. These hormones help regulate blood pressure, blood sugar levels, and electrolyte balance, so their deficiency can cause a range of symptoms that affect daily functioning. Although the diagnosis may sound alarming, with proper treatment the condition can be well managed. Regular medication use and medical supervision allow most people to live completely normal and active lives. Recognizing the symptoms and seeking medical care in time helps reduce the risk of complications and makes living with this disease easier.

What is Addison’s disease

Addison’s disease, also known as primary adrenal insufficiency, occurs when the adrenal glands stop producing enough of the hormones cortisol and aldosterone. Cortisol helps the body manage stress and regulate metabolism, while aldosterone controls the balance of sodium and potassium, which affects blood pressure and fluid levels.

The condition can develop at any age but is most often diagnosed in people between 30 and 50 years old.

There are two forms of the disease:

• Primary insufficiency – when the problem is in the adrenal glands themselves.
• Secondary insufficiency – when the pituitary gland does not produce enough ACTH, the hormone that stimulates the adrenal glands.

A reduced production of these hormones causes symptoms that usually develop gradually but can sometimes lead to a sudden worsening known as an Addisonian crisis.

Causes of Addison’s disease

The most common cause is an autoimmune disorder, where the immune system attacks the body’s own tissues and gradually damages the adrenal glands. In developed countries, autoimmune causes are by far the most frequent.

Other possible causes include:

• Infections – tuberculosis, HIV, and certain fungal infections can affect the adrenal glands and impair their function.
• Tumors and bleeding – in rare cases, a tumor or bleeding in the adrenal glands can cause damage.
• Genetic factors – some inherited diseases and syndromes are associated with a higher risk.
• Secondary forms of the disease – long-term use of corticosteroids or pituitary disorders can result in hormone deficiency.

Identifying the cause is important for planning treatment and reducing the risk of complications, since the therapeutic approach depends on the underlying problem.

Symptoms of Addison’s disease

Symptoms develop gradually and often resemble signs of other conditions, which can delay diagnosis. Complaints usually do not appear immediately but become noticeable only when a large portion of the adrenal cortex is damaged and hormone production is significantly reduced.

Common symptoms include:

• chronic fatigue and weakness,
• weight loss and decreased appetite,
• dark patches on the skin (hyperpigmentation),
• low blood pressure and dizziness.

In addition to these, nonspecific symptoms may also occur, such as nausea, vomiting, abdominal pain, irritability, or depression. 

An Addisonian crisis is a sudden worsening of the condition, marked by a rapid drop in blood pressure, dehydration, confusion, or loss of consciousness. This is a medical emergency and requires hospital treatment.

How Addison’s disease is diagnosed

The diagnosis of Addison’s disease is made through a combination of physical examination, lab tests, and imaging. A doctor first looks for symptoms and physical signs such as skin darkening and low blood pressure, and then recommends further tests.

The most common tests include:

• Cortisol measurement – low levels of this hormone may indicate a problem.
• Aldosterone testing – used to assess electrolyte balance and blood pressure.
• ACTH stimulation test – evaluates how the adrenal glands respond.
• Electrolyte analysis – changes in sodium and potassium levels often accompany the disease.
• Imaging (CT or MRI) – used to evaluate the adrenal glands and detect tumors or damage.

If an autoimmune cause is suspected, antibody testing is also performed. A combination of these results provides a complete picture for making the diagnosis.

Treatment of Addison’s disease

Addison’s disease cannot be completely cured, but it can be successfully managed with regular hormone replacement therapy.

The most common treatments include:

• Corticosteroid therapy – tablets that replace cortisol and help the body regulate stress and metabolism.
• Mineralocorticoids – medications that replace aldosterone and help maintain electrolyte balance and blood pressure.
• Dose adjustment during stress – during infections, surgery, or significant physical exertion, the dose is temporarily increased.
• Treatment of Addisonian crisis – in emergencies, hormones and fluids are given intravenously to quickly stabilize the condition.

Patients are advised to always carry their medication with them, as well as medical identification with information about the disease.

Addison’s disease and pregnancy

Women with Addison’s disease can become pregnant and have a successful pregnancy, but continuous monitoring by both an endocrinologist and a gynecologist is essential. Treatment is maintained throughout pregnancy, and corticosteroid doses are adjusted when necessary, particularly during labor, when the body is under additional stress.

Breastfeeding is generally possible, as standard therapy at usual doses does not interfere. However, it is recommended that each mother consult her doctor about any adjustments to treatment during this period.

Living with Addison’s disease

With regular treatment and monitoring, people with Addison’s disease can live active lives without major limitations. It is recommended to follow therapy consistently without skipping doses, carry medical identification, ensure sufficient salt intake during hot weather or physical exertion, and plan ahead, especially when traveling.

Life expectancy is largely comparable to that of the general population, but it is important to note that an Addisonian crisis can be life-threatening if not recognized and treated in time. With careful management of therapy and regular medical checkups, most people can lead a stable and long life.

Timely diagnosis and treatment lead to a stable life

Addison’s disease is a rare but serious condition that requires lifelong therapy and careful monitoring. With regular medication and medical supervision, it is possible to live a stable and fulfilling life. Recognizing symptoms early and obtaining the correct diagnosis are key to preventing complications such as an Addisonian crisis.

For anyone who wishes to check their hormone levels or suspects adrenal gland disorders, testing can be done at the IntroLab in Belgrade, where reliable laboratory analyses are performed. Timely testing and professional interpretation of results are the first steps toward an accurate diagnosis and proper treatment.