Addison’s disease occurs when the adrenal glands do not produce enough of two steroid hormones called cortisol and aldosterone. This can cause fatigue, weakness, digestion problems, dehydration, and mood changes.

The adrenal gland is part of an organ system known as the hypothalamic-pituitary-adrenal (HPA) axis. It responds to stressors by releasing hormones that prepare the body to flee from potential threats or confront them — the fight, flight, or freeze response.

This gland releases cortisol and aldosterone. Aldosterone helps balance blood pressure and electrolyte levels, while cortisol plays a key role in energy metabolism and immune activity. Due to damage to the adrenal gland, people with Addison’s disease do not produce enough of these important hormones.

This article explains the symptoms, causes, treatments, and outlook for Addison’s disease.

Female sitting at a desk with her head in her handsShare on Pinterest
filadendron/Getty Images

Symptoms of Addison’s disease vary from person to person. They develop slowly over time, so it is possible to confuse them with symptoms of other conditions.

People with Addison’s disease most often experience the following symptoms:

Other people might notice the following symptoms, although they are less common:

Learn more about the symptoms of Addison’s disease.

Addison’s disease develops due to damage in the outer layer of the adrenal gland, known as the adrenal cortex, which produces cortisol and aldosterone. Damage to the adrenal cortex reduces the amount of these hormones the gland can make.

Primary adrenal insufficiency

Most often, Addison’s disease occurs when a person’s immune system attacks healthy tissue in the adrenal cortex, making it an autoimmune disorder. Around 80–90% of people have the condition due to immune system issues.

Rarely, some infections also target the adrenal glands. People may also develop Addison’s disease after acquiring tuberculosis (TB) or due to reduced immune function resulting from HIV, which may cause more severe effects due to infections that affect the adrenal gland.

Other less common causes may include:

  • cancer growth in the adrenal glands
  • removal of the adrenal glands during surgery as treatment for other health issues
  • blood leaking into the adrenal glands
  • adrenal gland disorders that pass down in the genes
  • side effects of medications, such as antifungal medications

People often use the terms Addison’s disease and primary adrenal insufficiency interchangeably, according to the National Institute of Diabetes and Digestive and Kidney Disorders (NIDDK).

Secondary adrenal insufficiency

This occurs when a different gland — the pituitary gland — is less able to produce adrenocorticotropic hormone (ACTH), which controls and stimulates cortisol production. When the pituitary makes less ACTH, it affects levels of cortisol and other hormones.

Secondary adrenal insufficiency may develop due to:

  • autoimmune disorders
  • blood in the pituitary
  • genetic diseases that affect pituitary function
  • infection
  • pituitary tumors
  • surgical pituitary removal as a treatment for other conditions
  • brain injury or trauma

Tertiary adrenal insufficiency

When taking corticosteroids for a long time, consistently high levels of cortisol can occur. This also leads to lower production levels of corticotropin-releasing hormone (CRH) from the hypothalamus —the part of the brain that produces some hormones — which reduces ACTH output from the pituitary gland. This chain reaction means that the adrenal cortex produces less cortisol.

The adrenal glands may take several months to return to full function, even if a healthcare professional tapers off a corticosteroid dose slowly.

The same may apply after the treatment of Cushing’s disease, a condition that causes consistently high cortisol that can develop due to a pituitary gland tumor. Removal of the tumor can lead to low cortisol while the adrenal gland regains function.

Read more about the causes of Addison’s disease.

A person’s risk for Addison’s disease increases if they have the following conditions that affect hormones or the HPA:

Addison’s disease symptoms often develop between 30 and 50 years of age. The condition is most common in people assigned female at birth.

Addison’s disease diagnosis involves two steps: testing for low cortisol and aldosterone levels and identifying the cause.

Blood tests to identify low cortisol include:

  • an ACTH stimulation test
  • an insulin tolerance test
  • a CRH stimulation test

To find the cause, a healthcare professional may also request the following:

  • antibody tests to gauge the immune system responses
  • CT scans to check for bleeding, infections, or tumors on the adrenal glands
  • TB testing

Learn more about diagnosing Addison’s disease.

People with Addison’s disease typically need lifelong treatment with medications. They may also need to make lifestyle adjustments.


People with primary adrenal insufficiency will require daily medications for the rest of their lives to replace cortisol and aldosterone.

Cortisol replacement therapy options include:


Individuals with low aldosterone may benefit from eating high sodium foods. However, fludrocortisone may reduce the need to increase sodium intake.

Foods high in vitamin D and calcium can also help offset the increased risk of osteoporosis that someone may develop after taking corticosteroids for a long period.

Learn more about treatment for Addison’s disease.

With effective management, most people with Addison’s disease are able to live active lives. They generally need to attend regular consultations and checkups to ensure they receive the correct dose of corticosteroids. Receiving too high a dose can lead to:

Up to half of all people with Addison’s develop another autoimmune condition.

Adrenal crisis, or Addisonian crisis, also becomes a risk if a person does not properly take their medication. This is a life threatening complication that can lead to the following symptoms:

  • low blood pressure
  • shock
  • severe dehydration
  • confusion
  • low blood sugar
  • severe muscle weakness
  • intense sweating
  • cold, clammy, pale skin
  • shallow, quick breathing
  • dizziness, drowsiness, or unconsciousness
  • headache

Wearing a medical alert bracelet lets medical professionals know of an Addison’s disease diagnosis and details of an emergency contact.

The following are answers to some questions people frequently ask about Addison’s disease.

What are the first symptoms of Addison’s disease?

The early symptoms of Addison’s disease may include:

  • fatigue
  • muscle weakness
  • appetite and weight loss
  • muscle weakness
  • regular thirst

Is Addison’s disease life threatening?

Adrenal crisis, or Addisonian crisis, can be life threatening. However, taking daily cortisol replacement therapy medications as a healthcare professional directs can reduce the risk of an adrenal crisis.

Addison’s disease develops when an individual is no longer able to produce enough cortisol or aldosterone to respond to stress. Depending on the type, it can occur due to damage or illness in the adrenal glands.

The most common type is primary adrenal insufficiency, affecting the adrenal glands.

Symptoms include fatigue, low mood, weight loss, muscle weakness, and abdominal pain. Daily cortisol replacement therapy medication can help people maintain their quality of life.