About Addisons's disease

The adrenal glands
on Wed 24 Aug


About the Adrenal Glands

Located at the top of each kidney, the adrenal glands are triangular shaped hormone producing glands which regulate several important functions of the human body.  They secrete the following important hormones:

  • Glucocorticoids which help regulate blood sugar, blood pressure, fat & protein metabolism and immunity
  • Mineralocorticoids which help to regulate the kidney and heart function
  • Catecholamines which help to regulate your “fight or flight” response
  • Adrenal androgens which are precursors to sex hormones such as testosterone and oestrogen.

There are two main adrenal gland disorders – Addison’s disease and Cushing’s syndrome unfortunately these can be fatal if left untreated. In this post I explain…


Addison’s disease (hypoadrenalism)

The steroid hormone cortisol which is secreted by the adrenal glands is vital for life – it not only regulates blood pressure it also regulates the body’s response to infections, stress, physical accidents and surgery.


Diagnosing falling cortisol levels, this condition was named after Dr Thomas Addison after he discovered its existence in 1855 due to TB infiltration of the adrenal gland.  Addison’s disease is rare with approximately 8,000 UK patients at any one time, whilst it can occur at any age most people are between 30 and 50 when it develops.


The most common cause of Addison’s disease is now autoimmune disorder in developed countries where it may be associated with thyroid disease, type 1 diabetes or pernicious anaemia. In the third world its most common cause remains tuberculosis. This is then called primary adrenal failure.


It can also occur as a side effect of a failing pituitary gland whereby there are low levels of ACTH - the hormone responsible for the production and release of cortisol from the adrenal glands.


Secondary adrenal failure can additionally occur as a consequence of high-dose long-term steroid treatment when normal adrenal gland function is suppressed for example:

  • In immune disorders such as rheumatoid arthritis
  • for allergic disorders such as asthma and
  • to prevent transplant rejection


Signs and Symptoms

Clinical signs and symptoms normally don’t appear until at least 90% of the adrenal cortex is destroyed and these can be so slow in onset that the condition is not likely to be diagnosed until an adrenal crisis is brought on by stress caused by illness, trauma or surgery.


The symptoms of those with insufficient cortisol leading up to a crisis are:

  • Generalised weakness
  • Low blood pressure when standing
  • Chronic fatigue
  • Weight loss (mostly from anorexia, partly from dehydration)
  • Extreme sensitivity to drugs such as narcotics
  • Being nauseated and even sick
  • Craving for salty foods
  • Cramps and pains in muscles and stomachs
  • Spasmodic bouts of loose bowel movements or constipation
  • Irregular or ceased periods
  • Loss of axillary and pubic hair


Because these non-specific symptoms (in which overwhelming fatigue is the common denominator) could relate to many conditions Addison’s disease is difficult to diagnose. One patient survey revealed that 60% had seen two or more clinicians before the disease is actually diagnosed weeks or even months after the first vague symptoms present themselves.


In primary adrenal failure, as the disease develops pigmentation changes may also be seen around:

  • The creases of the hands
  • Gums and the inside of the mouth (which starts to look bluish)
  • Recent scars
  • Pressure points like elbows
  • Armpits


Signs of an Adrenal Crisis

The following clinical and laboratory features suggest an adrenal crisis which is life threatening and requiring urgent treatment

  • Dehydration, abnormally high blood pressure or shock which is out of proportion to the severity of current illness
  • Nausea and vomiting with a history of weight loss and anorexia
  • Severe abdominal pain mimicking acute disease or injury to an internal organ
  • Unexplained lack of glucose in the blood sugars
  • Unexplained fever
  • Investigations including abnormally low sodium levels; higher than usual potassium levels, higher than usual calcium levels or higher than usual white blood cells called eosinophils
  • Other autoimmune endocrine deficiencies such as hypothyroidism or type I diabetes, or family history of organ specific autoimmune endocrine diseases.



For those with Addison’s disease treatment is normally through the medication hydrocortisone which, taken in divided doses during the day, replaces the cortisol your body is not making. Usually fludrocortisone is added to treat the associated mineralocorticoid deficiency.


It is essential that patients carry a warning card or MedicAlert bracelet to warn medical staff that steroid treatment is required  in a medical emergency. They also need to be aware of “sick day” rules and know to increase their dose if they feel unwell for any reason – usually ill enough to take to their bed - or at the time of surgery.


For those in an adrenal crisis (which is the second most common cause of death in patients with known Addison’s disease and accounts for 15% of patients with this disease) urgent treatment with hydrocortisone injections and intravenous rehydration with fluids are essential. An emergency hydrocortisone injection kit can be prescribed by your GP which is important if you are going abroad.


Helpful Resources

Developed by the Addison’s Disease self-help group (www.addisons.org.uk) the following leaflets may be helpful to you

Managing your Addison’s

Diagnosing Addison’s: a guide for GP’s


To read my second post on adrenal disorders which covers Cushing's disease and Cushing's syndrome please click here


Although every effort is made to ensure that all health advice on this website is accurate and up to date it is for information purposes and should not replace a visit to your doctor or health care professional.

As the advice is general in nature rather than specific to individuals Dr Vanderpump cannot accept any liability for actions arising from its use nor can he be held responsible for the content of any pages referenced by an external link.



acanthosis nigricans Acromegaly Addison's disease adolescent diabetes problems adolescent thyroid problems Adrenal crisis adrenal fatigue Adrenal glands Anovulation artificial pancreas Autoimmune Thyroiditis Bariatric Surgery blood glucose levels blood pressure breastfeeding CAH Charcot foot cholesterol CHT coffee cold and flu medications Conception Congenital adrenal hyperplasia congenital hypothyroidism Consultant Endocrinologist London coronavirus cortisol covid-19 Cushing's disease Cushing's syndrome Depression Diabetes diabetes and bone health diabetes and heart health diabetes and oral health diabetes and parkinsons diabetes and sexual dysfunction diabetes and skin conditions diabetes and thrush diabetes in China diabetes insipidus diabetes latest diabetic ketoacidosis diabetic neuropathy Diabetic prevalence diabetic retinopathy diet for diabetes diet for obesity Disability Act Down's Syndrome Dr Mark Vanderpump e-consulting endocrine system fertility folic acid Freestyle Libre frozen shoulder and thyroid Fruit sugars gestational diabetes Gigantism Glucose Monitoring Glucose Tolerance Test gluten free Goitre Graves Disease Graves Orbitopathy guthrie test hair loss Hashimoto's Disease healthcare services hearing loss Heart Disease heel prick test Hepatitis C Hormones - most important how to lose weight hyperparathyroidism Hypersecretion Hyperthyroidism hyperthyroidism and respiratory problems Hypocalcaemia Hypogonadism hypoparathyroidism hypophysitis Hyposecretion Hypothyroidism hypothyroidism and respiratory problems IFG IGT immunotherapy side effects Impaired Fasting Glucose Impaired Glucose Tolerance Insulin Resistance Iodine IR iron Labour and birth late onset hypogonadism Levothyroxine Long Covid losing weight Low testosterone Mark Vanderpump MEN1 MEN2 menopause metabolic syndrome mood changes morning sickness Multiple endocrine neoplasia neuroendocrine tumour neuropathy Obesity obstructive sleep apnoea older patients online doctor OSA Osteoporosis overactive thyroid ozempic Pancreas Pancreatic Cancer Pancreatic Diabetes parathyroid glands Patient Resources Patient Support Groups PCOS PCOS and acne PCOS and fertility PCOS and Insulin PCOS diet Phaeochromocytomas Pituitary Gland POF Polycystic Ovary Syndrome Post menopause thyroid problem Post pregnancy thyroid problem postnatal diabetes medication postnatal thyroid medication Prader-Willi Syndrome pre-eclampsia prediabetes pregnancy Pregnancy and Diabetes Pregnancy and Thyroid Disease Premature Ovarian Failure prolactinomas PTH puberty Radioactive Iodine RAI resistant hypertension semaglutide Sheehan's Syndrome Skin tags sleep and diabetes sleep and obesity soy Soya steroid dependent subacute thyroiditis T4 Tara Palmer Tomkinson testosterone Tetany The endocrine system Thyroid thyroid and menstruation thyroid cancer Thyroid disease in children thyroid nodules Thyroid Storm thyroid tests Thyroiditis Thyrotoxic Periodic Paralysis Thyroxine TSH levels TSH Testing tumours Type 1 diabetes Type 2 Diabetes Type 3 diabetes underactive thyroid Vitamin B complex Vitamin D Waist circumference weight gain weightloss

Please get in touch

Phone: 07565 978310

Contact form