Addison's Disease - Specialists and Information

When it comes to symptoms, a distinction must be made between long-term insufficiency and a sudden onset of what is known as an Addisonian crisis. In the primary form, symptoms do not appear until more than 90% of the adrenal cortex has been destroyed. Patients typically have very tanned skin and are often tired and listless. They usually have low blood pressure and often complain of nausea and vomiting. The disease often goes undetected and only becomes apparent in stressful situations, such as after surgery, accidents, or other serious illnesses.

An Addisonian crisis is characterized by typical symptoms such as tanned skin, fatigue, nausea, as well as dehydration, decreased urine output, and a drop in blood pressure. These are accompanied by low blood sugar and severe abdominal pain.

Primary adrenal insufficiency is much more common than secondary adrenal insufficiency, and in most cases, the primary form is caused by the destruction of the adrenal glands by autoantibodies—that is, an autoimmune process. This autoimmune form of the disease is called Addison’s disease.

The diagnosis can be easily confirmed through a few laboratory tests. In primary adrenal insufficiency, blood levels of cortisol and mineralocorticoids are too low. This leads to increased secretion of the upstream hormone ACTH. In the secondary form, there is reduced secretion of ACTH, but because adrenal cortical function is not impaired, mineralocorticoid production remains normal.

If AD is suspected, cortisol levels and blood electrolytes are measured. In an acute situation, there is too little sodium and too much potassium in the blood because the hormone responsible for electrolyte balance is lacking. This hormone is the mineralocorticoid aldosterone.

A test is used to confirm the diagnosis. In this test, a hormone is injected that, in healthy individuals, stimulates the adrenal glands to produce cortisol. If the cortisol level in the blood does not rise, Addison’s disease is present. To determine whether the condition is primary or secondary, ACTH levels are measured. In the primary form, ACTH levels in the blood are elevated, whereas in the secondary form, they are reduced.

Treatment consists of lifelong cortisol and, in the case of the primary form, aldosterone replacement therapy. The dose is adjusted to ensure that blood pressure and electrolyte levels are well controlled and that patients feel well.