Addison disease

Salt craving

A craving for salt is one of the symptoms that can develop in Addison's disease, alongside tiredness, nausea, vomiting, belly pain, aching muscles, and weight loss.

Orthostatic hypotension

Initial vital signs showed tachycardia and orthostatic hypotension with hyponatremia identified during work up.

Tachycardia

A fast heartbeat can occur in Addison's disease, often together with low blood pressure on standing and low blood sodium.

Increased circulating ACTH level

The pituitary gland, sensing the cortisol shortage, pumps out more of its signal hormone ACTH. The high ACTH confirms the problem is in the adrenal glands and also drives the characteristic skin darkening.

Decreased circulating aldosterone concentration

In Addison's disease, the immune system damages the adrenal glands, causing low levels of both cortisol and a hormone called aldosterone that helps control salt and fluid balance.

Decreased circulating cortisol level

A low blood cortisol level, especially in the morning when it should be highest, is the central finding. Cortisol helps the body respond to stress and illness, so a shortage leads to fatigue, low blood pressure, and poor tolerance of infection.

Primary adrenal insufficiency

The core problem is primary adrenal insufficiency: the failure is in the adrenal glands themselves, not in the pituitary signal telling them to work. That distinction is why the body's signal hormone, ACTH, is high while the adrenal hormones are low.

Asthenia

A deep lack of energy and strength (asthenia) was the most common symptom at the start of primary adrenal insufficiency in this group, alongside skin darkening and low blood sodium. Their absence, though, does not rule the condition out.

Fatigue

Ongoing fatigue is a common symptom of Addison's disease and often appears alongside low blood pressure and darkening of the skin.

Hyperpigmentation of the skin

Darkening of the skin (hyperpigmentation) is frequently seen in Addison's disease. It is linked to a long-standing rise in adrenocorticotropic hormone (ACTH), the signal the body sends when the adrenal glands are underactive.

Anti-21-hydroxylase antibody positivity

In autoimmune Addison's disease, a blood test for 21-hydroxylase antibodies is usually positive. These antibodies target an enzyme in the adrenal gland and confirm that the cause is autoimmune, which also raises the chance of other autoimmune conditions.

Autoimmunity

SARS-CoV-2 infection may act as an environmental trigger that shifts hidden autoimmunity into active disease in people who are genetically prone to it. Whether the virus plays a direct causal role is still uncertain.

Hyperkalemia

High blood potassium (hyperkalemia) is common in Addison's disease, often appearing together with low blood sodium.

Dehydration

When the body doesn't make enough aldosterone, it can't properly balance sodium and potassium, which can lead to low blood pressure and dehydration.

Hyponatremia

Low blood sodium (hyponatremia) is common in Addison's disease, often appearing together with high blood potassium.

Nausea and vomiting

Nausea and vomiting can be persistent, wearing symptoms in adrenal insufficiency, often together with loss of appetite and feeling full quickly. Because these gut symptoms are not specific, they can be mistaken for another problem early on.

Adrenal crisis

In Addison disease, a sudden severe shortage of cortisol can cause an adrenal crisis, a life-threatening emergency. Steroid replacement helps prevent it.

Addison disease

Diagnosed using: Morning serum cortisol.

Addison disease

Diagnosed using: Plasma ACTH.

Addison disease

Diagnosed using: Adrenal cortex antibodies.

Addison disease

Diagnosed using: ACTH stimulation test.

hydrocortisone

An adrenal crisis is treated promptly with intravenous fluids, support for blood pressure, and a stress dose of hydrocortisone given into a vein. This emergency hydrocortisone replaces the cortisol the body cannot make.

Used to help with: Addison disease.

fludrocortisone

Fludrocortisone is the mineralocorticoid replacement used in primary adrenal insufficiency. It stands in for aldosterone, the hormone that helps the body hold on to salt and keep blood pressure and potassium in balance.

Used to help with: Addison disease.

corticosteroid replacement therapy

Corticosteroid replacement therapy is the mainstay of treatment for Addison's disease, replacing the hormones the adrenal glands can no longer make. Even with it, the condition still carries higher mortality and a reduced quality of life, which is why ongoing care matters.

Used to help with: Addison disease.

stress-dose (sick-day) glucocorticoid

People on a steady replacement routine still need higher doses during illness or physical stress, such as a viral infection or surgery. These extra stress doses (sick-day dosing) cover the body's increased need for cortisol and help head off an adrenal crisis.

Used to help with: Addison disease.