Addison’s disease and Cushing disease both relate to the adrenal glands and the production of cortisol and aldosterone. Addison’s disease causes a lack of cortisol, while Cushing disease causes excess cortisol.

The adrenal glands sit above each kidney and release hormones, including aldosterone and cortisol, which help control various body functions.

This article covers the differences between Cushing disease and Addison’s disease.

Phials in a box -2Share on Pinterest

A key difference between Cushing disease and Addison’s disease is cortisol production.

Addison’s disease is a condition in which the adrenal glands are underactive and do not produce enough cortisol and, in some cases, not enough aldosterone.

With Cushing disease, the adrenal glands are overactive. This occurs due to a benign pituitary tumor, which causes excessive cortisol production.

A person may experience the following symptoms:

Cushing disease

Symptoms of Cushing disease include:

In children, Cushing disease may slow growth, delay puberty, and cause weight gain.

Addison’s disease

Signs and symptoms of Addison’s disease include:

The following are causes and risk factors for Cushing disease and Addison’s disease.

Cushing disease

A benign pituitary tumor causes Cushing disease. The tumor makes the pituitary gland produce excess adrenocorticotropic hormone (ACTH). ACTH is the hormone that triggers the adrenal glands to produce cortisol. Increased ACTH results in excess cortisol.

The pituitary tumors in Cushing disease can occur due to a genetic mutation.

In most cases, there is no known cause of the pituitary tumors. In a few cases, multiple endocrine neoplasia type 1, an inherited disorder, may cause the tumor.

Addison’s disease

Causes of Addison’s disease may include:

  • autoimmune diseases
  • infections, such as HIV or tuberculosis
  • bleeding into the adrenal glands
  • other conditions affecting the adrenal glands, such as cancer or an iron overload
  • certain medications that block cortisol production, such as ketoconazole and etomidate

Addison’s disease is more common in females and adults between the ages of 30 to 50 years. Risk factors include autoimmune conditions such as:

The treatment options for Cushing disease and Addison’s disease are as follows.

Cushing disease

Treatment may include:

  • medications, such as metyrapone and ketoconazole, to reduce cortisol levels, usually as a short-term option before surgery
  • surgery to remove the pituitary tumor
  • surgery to remove the adrenal glands, if removal of the pituitary tumor is not possible or effective
  • radiotherapy to the pituitary tumor, if surgery is not possible or effective

Addison’s disease

Treatment for Addison’s disease may include hormone replacement medications.

A doctor may prescribe hydrocortisone to replace cortisol, or another corticosteroid such as prednisone or dexamethasone. To replace aldosterone, doctors may prescribe fludrocortisone.

If people have an adrenal crisis, a complication of Addison’s disease, they will need immediate medical care. This may include intravenous (IV) corticosteroid injections or IV salt solution with dextrose, a type of sugar.

The following outlines how doctors diagnose each condition.

Cushing disease

Diagnosis may include:

  • a urine sample to measure cortisol levels
  • a blood test after taking dexamethasone
  • cortisol tests via blood or saliva sample
  • an MRI scan of the pituitary gland

Addison’s disease

Diagnosis for Addison’s disease may include:

  • ACTH stimulation test, a blood test following an injection of synthetic ACTH, to check cortisol levels
  • insulin tolerance test, a blood test to check stress response after an insulin injection

The following outlines the outlook of each condition.

Cushing disease

Surgery to remove the pituitary tumor is usually successful in 80% of people with Cushing disease.

After curing Cushing disease, cortisol levels and symptoms will return to normal within weeks or months. A relapse is possible, so long-term monitoring is important.

After treatment, people will need lifelong hydrocortisone treatment due to the lack of cortisol production in the body.

People with Cushing disease may be at risk of osteoporosis, so supporting bone health is important.

Addison’s disease

Addison’s disease requires lifelong treatment with hormone replacement, but most people can live a typical, active life.

Up to 50% of people with Addison’s disease may develop an additional autoimmune disease, so ongoing monitoring is important.

An adrenal crisis is a severe complication of Addison’s disease, which can be life threatening, so prompt medical treatment is essential.

What happens when someone with Addison’s disease gets stressed?

People with Addison’s disease may lack enough cortisol to cope with significant stress. This can lead to an adrenal crisis, which is a medical emergency.

If people are experiencing increased stress, they can talk with a doctor, as they may need to increase their medication.

Does Addison’s disease cause a person to become angry?

Addison’s disease can cause changes in mood, emotions, and behavior. This may cause irritability, depression, or affect concentration.

Can you drink alcohol if you have Addison’s disease?

People with Addison’s disease may be able to drink alcohol in moderation. However, excessive alcohol intake may lead to vomiting, which can trigger an adrenal crisis.

How do Addison’s disease and Cushing disease differ from Graves’ disease?

Graves’ disease is an autoimmune condition in which the immune system attacks the thyroid gland, causing it to produce excess thyroid hormone.

Addison’s disease and Cushing disease are both adrenal gland disorders. Addison’s disease causes a lack of cortisol, while Cushing disease causes excess cortisol.

Treatment for Cushing disease may include surgery to remove a pituitary tumor. Treatment for Addison’s disease includes corticosteroids.