Addison’s disease: symptoms, causes, and proven treatments

If you're exhausted, craving salty foods, getting dizzy when you stand up, and losing weight without trying, please know you're not "just tired." These can be classic Addison's disease symptomsan adrenal insufficiency where your adrenal glands aren't making enough cortisol (and often aldosterone). It's serious, but with the right care, it's absolutely manageable.

The path forward starts with recognizing what's happening, getting the right tests, and learning a few life-saving "sick-day" rules to prevent an adrenal crisis. In this guide, we'll walk through what to watch for, how doctors diagnose it, the Addison's disease treatment that actually works, and how to live well day to daywithout fear running the show.

What it is

Addison's disease is primary adrenal insufficiency. Translation: the adrenal glands themselves are the problem. They sit on top of your kidneys like tiny caps and, under normal circumstances, make hormones that help you respond to stress, keep your blood pressure steady, and balance salts and fluids.

Quick definition and why it matters

In Addison's disease, your adrenal glands can't make enough cortisol (your stress-response hormone) and often not enough aldosterone (the one that helps you retain salt and water). Without those, your energy plummets, blood pressure drops, and your body struggles in even minor illnesses. The good news? Replacing those hormonesthoughtfullygives most people their life back.

Addison's vs. adrenal insufficiency

"Adrenal insufficiency" is the umbrella term. Addison's disease is one typeprimary adrenal insufficiencywhere the adrenals are damaged. Secondary adrenal insufficiency happens when the pituitary gland in your brain doesn't send enough ACTH (the "please make cortisol" signal) to healthy adrenal glands. Same end result (low cortisol), but different cause and some different symptoms.

Cortisol and aldosteronewhat they do

Think of cortisol as your body's head coach during stress: it mobilizes energy, stabilizes blood pressure, tames inflammation, and keeps blood sugar balanced. Aldosterone is your fluid and salt manager: it helps your kidneys retain sodium and water while letting go of potassium, which keeps your blood pressure and hydration on track.

How common is it and who gets it?

Prevalence and typical age

Addison's disease is rareoften quoted around 100 to 140 cases per million people. It can occur at any age, but many are diagnosed in mid-adulthood. Because the symptoms creep in slowly, people sometimes go months or years before a proper diagnosis.

Related autoimmune conditions

The most common cause is autoimmune adrenalitis. That means people with Addison's may also have other autoimmune conditions like thyroid disease (Hashimoto's or Graves'), type 1 diabetes, pernicious anemia, or vitiligo. If this is you, your care team may screen for these as part of your long-term plan.

Key symptoms

Let's talk about what Addison's disease feels like in real life. Picture a battery that never fully charges, mixed with salt cravings so strong you'd drink pickle juice. It's not just "being dramatic"it's physiology.

Early, slow-burn symptoms

Fatigue, weight loss, appetite, GI, aches

Common early signs: dragging fatigue, unintentional weight loss, poor appetite, nausea, vomiting, diarrhea, and muscle or joint aches. Many people describe "just not feeling right" for a long time.

Dizziness, salt cravings, low sugar episodes

Dizziness when you stand (postural hypotension) is a big clue. Salt cravings show your body is trying to fix low aldosterone. Some experience low blood sugar symptomssweats, shakiness, brain fogespecially if meals are delayed.

Skin and hair changes, mood, sex drive

Hyperpigmentationdarkening of skin in scars, skin folds, knuckles, elbows, or gumscan be striking. Women may notice body hair loss. Mood changes like irritability, low mood, or apathy are common. And yes, low sex drive can be part of the picture.

Signs of adrenal crisis (emergency)

Sudden severe weakness and pain

Adrenal crisis can strike during illness, injury, or severe stress. Watch for sudden severe weakness and intense pain in your abdomen, lower back, or legs.

Severe vomiting/diarrhea and fainting

Profuse vomiting or diarrhea, dehydration, very low blood pressure, and fainting are red flags. This is 911-level serious.

Confusion, fever, loss of consciousness

Confusion, fever, and loss of consciousness can develop quickly. If these happen, call emergency services. Immediate treatment with IV hydrocortisone and fluids saves lives.

When to see a doctor

Book an appointment soon if you have the slow-burn symptoms above, especially if you also notice skin darkening or salt cravings. Seek urgent care now if you're vomiting, fainting, too weak to stand, or confusedthose can be adrenal crisis warning signs.

Main causes

So why does Addison's disease happen? Here are the big categories.

Primary adrenal insufficiency (Addison's)

Autoimmune adrenalitis

Most cases are autoimmuneyour immune system mistakenly attacks the adrenal cortex. It's nobody's fault, and you didn't cause it. But it does mean lifelong hormone replacement is usually needed.

Infections, cancer, hemorrhage

Less commonly, infections like tuberculosis can damage the adrenals. Metastatic cancer and bilateral adrenal hemorrhage (bleeding into both glands, sometimes linked to severe illness or blood thinners) are rarer causes.

Genetics and medication-related

Genetic conditions like some forms of congenital adrenal hyperplasia can present in childhood or adulthood. Certain medications (ketoconazole, mitotane, etomidate, and other glucocorticoid antagonists) can block cortisol production.

Secondary adrenal insufficiency (related, not Addison's)

Low ACTH from pituitary issues

Diseases of the pituitary or hypothalamus, surgery, radiation, or traumatic brain injury can reduce ACTH. The adrenals are intact but under-stimulated.

Sudden steroid withdrawal

Stopping long-term steroid therapy (like prednisone) abruptly can temporarily suppress your body's own cortisol production. Tapering is essential.

Key differences

Secondary adrenal insufficiency usually doesn't cause skin darkening and more often shows hypoglycemia, with less severe dehydration and low blood pressure because aldosterone is usually preserved.

Diagnosis steps

Diagnosis is detective workand timing matters. Morning is prime time for testing because cortisol has a daily rhythm.

First steps your clinician may take

History, exam, medications

Your clinician will ask about symptoms, weight changes, and blood pressure. They'll check for hyperpigmentation, measure your blood pressure lying and standing, and review medications that can affect cortisol.

Core lab tests

Morning cortisol, ACTH, and electrolytes

Blood tests include an early morning cortisol level (often around 8 a.m.), ACTH, and a basic metabolic panel to check sodium, potassium, and glucose. Low sodium and high potassium nudge the diagnosis toward primary adrenal insufficiency.

ACTH stimulation (Synacthen) test

This is the cornerstone. You'll get synthetic ACTH (cosyntropin) and have cortisol measured before and after the injection. A healthy adrenal should raise cortisol robustly. A flat or inadequate rise points to adrenal insufficiency. In primary, ACTH is typically high; in secondary, ACTH is low or inappropriately normal. According to the Endocrine Society's guidance (clinical practice guideline), the 250-g ACTH test is standard, with lab-specific cutoffs.

Finding the cause

Renin/aldosterone and adrenal antibodies

High renin with low-normal aldosterone suggests mineralocorticoid deficiency, common in primary disease. A blood test for 21-hydroxylase antibodies helps confirm autoimmune Addison's.

Imaging when needed

CT of the adrenals can look for hemorrhage, calcifications from TB, or metastases. If secondary disease is suspected, pituitary MRI may be ordered.

Special testing in men

In adult men with unexplained primary adrenal insufficiency, clinicians may test very long-chain fatty acids to rule out X-linked adrenoleukodystrophy.

Best treatments

Here's the hopeful part: Addison's disease treatment is precise hormone replacementgiving your body what it's missing, in amounts that feel natural and safe.

Hormone replacement basics

Glucocorticoids: doses and timing

Most adults start with hydrocortisone divided in two or three doses (for example, morning and early afternoon) to mimic your body's natural rhythm. Some use prednisone or prednisolone once daily. Your clinician will personalize dosing based on symptoms, blood pressure, weight, and sometimes labs. The goal is the lowest dose that keeps you feeling well.

Mineralocorticoid: fludrocortisone

If aldosterone is low, fludrocortisone replaces it. This helps stabilize blood pressure, reduce dizziness, and correct sodium/potassium balance. Your team may also recommend a bit more salt in your diet, especially in hot weather or during exercise.

Sick-day rules and crisis prevention

When to increase your dose

If you have a fever, flu, a nasty stomach bug, significant injury, or are undergoing surgery or dental procedures, you'll likely need to increase your steroid dose temporarily ("stress dosing"). Your endocrinologist will give you a clear planoften doubling or tripling the usual glucocorticoid dose during moderate illness. According to widely used hospital protocols (NIDDK overview), surgery typically requires IV hydrocortisone before and after the procedure.

If you're vomiting or can't keep pills down

This is a big one. If you vomit and can't keep medication down, use your emergency hydrocortisone injection and go to the ER. Don't wait to see if it passes. Tell the team you have Addison's disease; they should give IV hydrocortisone and fluids quickly.

Emergency kit and medical ID

Carry an emergency kit with hydrocortisone injection, syringes, alcohol swabs, and written instructions. Wear a medical ID bracelet or necklace that says "Adrenal insufficiencyneeds hydrocortisone." It can turn a scary day into a safe one.

Monitoring and follow-up

Fine-tuning doses and labs

Expect regular check-ins to adjust your glucocorticoid and fludrocortisone. Your team may track blood pressure, electrolytes, and plasma renin to optimize mineralocorticoid dosing. Too much glucocorticoid can cause weight gain, insomnia, or bone loss; too little leaves you fatigued and dizzy. Small tweaks make a big difference.

Side effects and bone health

Because steroids can affect bones, your clinician might recommend calcium, vitamin D, weight-bearing exercise, and periodic bone density scans, especially if doses are higher or you have risk factors.

Lifestyle and practical tips

Hydration, salt, exercise, travel

Drink consistently, add salt as advised (particularly in heat or heavy workouts), and ease into exercisemost people can be active once stable. For travel, pack extra medication in your carry-on, bring a copy of your treatment plan, and keep your emergency injection within reach. I've heard more than one traveler say their medical ID turned a chaotic airport moment into calm, prompt care.

Vaccinations and infections

Stay current on vaccines to reduce infection risk. If you do get sick, start your stress-dose plan early and check in with your clinician if symptoms escalate.

Mental health and community

Chronic conditions can weigh on your mood. A counselor, support group, or patient community can be a lifeline. You're not "being dramatic"you're navigating real physiology and real life.

Living well

Let's talk about the long game: preventing crises, thriving at work, and feeling confident about the future.

Complications to know

Adrenal crisis triggers

Common triggers include gastroenteritis, high fever, surgery, dental procedures, major stress, dehydration, and missing doses. Reduce risk by following sick-day rules, carrying your emergency kit, and telling close friends or coworkers how to help in an emergency.

Associated autoimmune screening

Because Addison's often comes with other autoimmune conditions, your clinician may periodically screen thyroid function, B12, and blood glucose. Catching issues early keeps you feeling steady.

Prognosis and quality of life

Most people do well

With proper replacement and education, most people live full, active lives. Once doses are tuned, energy and mood often improve dramatically. Think of it like learning to drive a new caryou'll quickly get a feel for the dashboard signals your body gives you.

Work, activity, pregnancy

Work and exercise are absolutely possible. Just plan ahead for long days, heat, or intense workouts. Pregnancy is very possible toodoses are adjusted and labor is managed with stress-dose steroids. Close coordination with obstetrics and endocrinology keeps things smooth.

Finding balance

Benefits of replacement

Replacing missing hormones prevents adrenal crisis, restores energy, supports blood pressure, and lets you live life without the constant "low battery" alert in the background.

Risks and how to minimize them

Over-replacement can cause weight gain, insomnia, high blood pressure, and bone loss; under-replacement causes fatigue, dizziness, and crisis risk. Regular follow-up, the lowest effective dose, and attention to bone health minimize these risks. It's a partnership between you and your care team.

Compare disorders

It's easy to get mixed up by adrenal gland disorders. Here's how Addison's disease differs from a few look-alikes.

Addison's vs. secondary insufficiency

Key differences you'll notice

Addison's (primary) often includes skin darkening, salt wasting, low blood pressure, and high potassium. Secondary adrenal insufficiency usually lacks skin darkening and mineralocorticoid problems, but low cortisol symptoms (fatigue, low blood sugar) still appear.

Addison's vs. Cushing's syndrome

Too little vs. too much cortisol

Addison's is cortisol deficiency. Cushing's syndrome is cortisol excessthink weight gain around the middle, easy bruising, high blood pressure, and high blood sugar. Management and risks are polar opposites, which is why accurate diagnosis matters.

Checklist

Because information is greatbut checklists save brain space. Here's a simple starter list you can copy into your notes app.

New diagnosis essentials

Questions to ask your endocrinologist

• What glucocorticoid and dose should I start with, and how should I time it each day?
• Do I need fludrocortisone? How will we adjust itby blood pressure, renin, or symptoms?
• What's my sick-day plan for fever, vomiting, dental work, or surgery?
• When should I use my emergency injection, and who can help me administer it?
• What labs and how often will we monitor (electrolytes, renin, bone health)?
• Which vaccines should I prioritize this year?
• Could I have related autoimmune conditions? What screenings do you recommend?

Emergency kit and medical ID

• Hydrocortisone injection (Act-O-Vial or equivalent) and syringes
• Alcohol swabs, bandages, and written step-by-step instructions
• Spare oral hydrocortisone/prednisone in a labeled container
• Medical ID that says "Adrenal insufficiencyneeds hydrocortisone"
• Printed card with your diagnosis, doctor's contact, and dosing plan

Reliable support

Where to find guidance

For clear, clinician-aligned information on adrenal insufficiency and Addison's disease treatment, I like resources from major endocrine groups and academic centers, such as the Endocrine Society's guidelines and patient pages from established clinics. For example, the Endocrine Society's guideline on primary adrenal insufficiency (evidence-based recommendations) and overviews from national institutes (adrenal insufficiency overview) align with the approaches discussed here.

Wrap-up

Addison's disease can feel scary when you don't know what's going onfatigue, dizziness, weight loss, salt cravingsbut once you name it and replace the missing hormones, life gets a lot more manageable. The key is early diagnosis, a treatment plan you understand, and clear sick-day rules to prevent adrenal crisis. Keep your emergency kit and medical ID on you, see your care team regularly to fine-tune doses, and don't hesitate to seek help if you're unwell or can't keep meds down. If any red-flag crisis symptoms show up, get urgent care. What questions are on your mind right now? Jot them down and bring them to your next appointmentyour team is there to help, and so am I. You've got this.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.