Addison's Disease: Causes, Symptoms, and Treatments – Clinique Omicron
An adrenal crisis is a life-threatening emergency. It manifests as severe hypotension, intense vomiting, sharp abdominal pain, mental confusion, or loss of consciousness, often triggered by significant physiological stress (infection, surgery, trauma).
In case of suspected adrenal crisis, call 911 immediately:
Individuals with a known diagnosis should wear a medical alert card and have an injectable hydrocortisone kit at home, as recommended by their doctor.
Causes and mechanisms
Destruction of the adrenal cortex can result from several distinct pathological processes. In high-income countries, autoimmune causes account for approximately 70 to 90% of cases. In other settings, adrenal tuberculosis remains a major cause worldwide.
| Cause | Mechanism | Relative frequency |
|---|---|---|
| Autoimmune | Destruction of the adrenal cortex by anti-21-hydroxylase antibodies | 70 to 90 1Q–3Q |
| Adrenal tuberculosis | Bilateral granulomatous adrenal infection | Varies by region |
| Fungal infections and HIV | Infectious infiltration of the cortex | Less frequent |
| Adrenal metastases | Bilateral tumor invasion (lung, breast, kidney) | Rare |
| Bilateral adrenal hemorrhage | Ischemic necrosis (anticoagulants, meningococcal sepsis) | Rare |
| Genetic disorders (e.g., adrenoleukodystrophy) | Enzyme anomaly leading to toxic lipid accumulation | Rare |
Symptoms
The clinical manifestations of Addison's disease are initially progressive and non-specific, which complicates rapid identification of the condition. The symptoms are mainly due to the deficiency in cortisol and aldosterone.
| Symptom | Underlying mechanism |
|---|---|
| Profound chronic fatigue | Cortisol deficiency, the main regulator of energy metabolism |
| Low blood pressure and dizziness | Aldosterone deficiency, reducing sodium and water retention |
| Cutaneous and mucosal hyperpigmentation | Compensatory elevation of ACTH, stimulating melanocytes |
| Weight loss and anorexia | Disruption of carbohydrate and lipid metabolism |
| Nausea, vomiting, abdominal pain | Gastrointestinal effects of hormonal deficiency |
| Salt cravings | Compensatory mechanism for hyponatremia |
| Depression, irritability, cognitive impairment | Influence of Cortisol on Mood Regulation and Brain Function |
| Hypoglycemia (especially in children) | Role of cortisol in hepatic gluconeogenesis |
Diagnosis
The diagnosis is based on a combination of clinical and biological evaluations, and hormonal stimulation tests. It is made by a doctor, often confirmed by an endocrinologist.
- Morning serum cortisol (low value suggestive if below 140 nmol/L)
- Plasma ACTH measurement (elevated in primary insufficiency)
- Synacthen (Cosyntropin) Stimulation Test: Diagnostic Reference for Confirming Adrenal Insufficiency
- Anti-21-hydroxylase antibody assay (confirmation of autoimmune origin)
- Blood ionogram: search for hyponatremia and hyperkalemia
- Fasting blood glucose: screening for associated hypoglycemia
- Adrenal imaging (CT scan) according to clinical indication
- Thyroid screening and fasting blood glucose for screening of associated SPA
Treatments
Addison's disease does not resolve spontaneously. It requires lifelong hormone replacement therapy, tailored individually and adjusted according to physiological stress situations.
| Treatment | Role | Usual procedure |
|---|---|---|
| Oral hydrocortisone | Cortisol substitution | 15 to 25 mg/day in 2 to 3 divided doses |
| Oral fludrocortisone | Mineralocorticoid substitution (aldosterone) | 0.05 to 0.2 mg/day in a single dose |
| Oral DHEA (selected cases) | Improvement of well-being, libido, and mood | 25 to 50 mg/day as evaluated |
| Triple dose rule (sick day rules) | Adrenal Crisis Prevention During Stress | Double or triple the hydrocortisone dose during fever, infection, surgery |
| Hydrocortisone injectable (emergency kit) | Management of impending adrenal crisis | 100 mg IM/SC in an emergency, while awaiting medical assistance |
Long-term monitoring
Regular medical follow-up is essential for adjusting dosages, screening for associated conditions, and educating the patient on the autonomous management of at-risk situations. Parameters periodically evaluated include orthostatic blood pressure, ionogram, blood glucose, bone density, and perceived quality of life.
Dose adjustments are required during pregnancy, surgeries, severe infections, or radiological examinations with preparation (e.g., colonoscopy). The treating physician and endocrinologist should be informed in advance.
Consult at Clinique Omicron
Clinique Omicron, at its service points in Quebec, offers medical consultations for the evaluation of symptoms suggestive of an endocrine disorder, including unexplained chronic fatigue, persistent hypotension, or abnormal skin pigmentation. Our physicians can perform the initial assessment, coordinate the necessary hormonal tests, and refer to an endocrinologist when diagnosis or management requires it. For individuals already diagnosed, a consultation at one of our service points also allows for structured follow-up, assessment of the adequacy of replacement therapy, and uninterrupted prescription renewals.
The content of this page is provided for informational purposes only and is not intended to replace the advice of a qualified healthcare professional. Consult a physician for any symptoms, questions or decisions you may have regarding your health.
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