Addison's Disease
Adrenal insufficiency causing fatigue, weight loss, and low blood pressure.
TL;DR
Addison\u0027s disease is adrenal gland failure requiring lifelong hormone replacement — it is a medical emergency if untreated and is never a supplement-treatable condition. \u0027Adrenal fatigue\u0027 is a different, scientifically unsupported concept.
Overview
Addison\u0027s disease (primary adrenal insufficiency) results from destruction of the adrenal cortex — most often autoimmune in developed countries, tuberculosis worldwide — causing deficiency of cortisol and usually aldosterone. Symptoms are insidious: fatigue, weight loss, salt craving, hyperpigmentation, orthostatic dizziness. The danger is adrenal crisis, a life-threatening emergency of hypotension, hypoglycemia, and shock triggered by illness or stress in an undiagnosed or under-replaced patient.\n\nDiagnosis is biochemical: a morning cortisol below threshold with elevated ACTH, confirmed by cosyntropin (Synacthen) stimulation testing. Treatment is lifelong glucocorticoid replacement (hydrocortisone in divided doses) plus mineralocorticoid (fludrocortisone) in primary disease, with sick-day dose doubling and an emergency steroid injection kit — this education saves lives.\n\nCrucially, no supplement treats or substitutes for hormone replacement, and patients must never taper steroids for adaptogens or glandulars. Licorice can potentiate cortisol and complicate management; so-called adrenal support products occasionally contain undeclared hormones that suppress the axis further. Patients and families should know the sick-day rules cold.
Common Symptoms
- •Progressive fatigue and weakness
- •Weight loss and poor appetite
- •Salt craving
- •Skin hyperpigmentation (palmar creases, scars, buccal mucosa)
- •Orthostatic dizziness
- •Nausea, abdominal pain
- •Hypoglycemia
Common Causes
- •Autoimmune adrenalitis (most common in developed countries)
- •Tuberculosis and other infections
- •Adrenal hemorrhage or metastases
- •Genetic or infiltrative disorders
- •(Secondary: chronic glucocorticoid use suppressing the axis)
How It's Diagnosed
Diagnostic Markers
- 8–9 AM serum cortisol and ACTH
- Cosyntropin stimulation test (definitive)
- Electrolytes: hyponatremia, hyperkalemia
- Renin (elevated in primary disease)
- 21-hydroxylase antibodies for autoimmune confirmation
When to See a Doctor
Addison\u0027s requires specialist endocrine care at diagnosis and for life. Vomiting, severe weakness, confusion, or collapse in a patient with adrenal insufficiency is an emergency — give the stress-dose injection and call emergency services.
Diet & Lifestyle
Suggested Pattern
No specific diet treats Addison\u0027s; adequate salt intake is encouraged in primary disease, and a steroid-aware eating pattern (protein, calcium, vitamin D) mitigates long-term glucocorticoid effects.
Eat more
- Adequate dietary salt (unlike most conditions)
- Calcium and vitamin D sources for bone protection
- Regular balanced meals to avoid hypoglycemia
Avoid
- Licorice (potentiates cortisol, disturbs potassium)
- Grapefruit in large amounts (CYP3A4 interaction with some steroids)
Supporting Research
Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society clinical practice guideline
A systematic review and meta-analysis of randomized placebo-controlled trials of DHEA treatment effects on quality of life in women with adrenal insufficiency
Improved cortisol exposure-time profile and outcome in patients with adrenal insufficiency: a prospective randomized trial of a novel hydrocortisone dual-release formulation
Replacement of dehydroepiandrosterone in adrenal failure: no benefit for subjective health status and sexuality in a 9-month, randomized, parallel group clinical trial
Frequently Asked Questions
Who It Affects
Primary adrenal insufficiency affects roughly 100–140 per million people in Western populations.
Autoimmune Addison\u0027s peaks between ages 30–50 and is more common in women; it clusters with other autoimmune disease (thyroid, type 1 diabetes, vitiligo).
Quick Facts
- •Adrenal crisis is preventable — sick-day rules and injection kits save lives
- •Never stop replacement steroids abruptly
- •Adrenal fatigue is not Addison\u0027s disease and has no scientific basis
- •Hyperpigmentation and salt craving are distinctive clues
Lifestyle Tips
- •Wear medical alert identification at all times
- •Carry an emergency hydrocortisone injection kit and know how to use it
- •Double oral doses during fever or illness; inject if vomiting
- •Review stress dosing before surgery, dental work, or travel
- •Get annual endocrine review including bone health
My Notes
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This information is for educational purposes only. Always consult a healthcare professional before starting any supplement regimen.