Addison’s Disease Addison’s disease, also called chronic adrenal insufficiency, hypocortisolism, and hypoadrenalism, is a rare, long-term endocrine disorder in which the adrenal glands produce insufficient steroid hormones. In primary adrenal insufficiency, the problem originates in the adrenal glands themselves, leading to inadequate glucocorticoids and, in many cases, inadequate mineralocorticoids as well. Common contributing causes include autoimmune destruction of the adrenal cortex, certain infections, and less frequently other adrenal or genetic disorders. Risk is increased in people with autoimmune conditions, and the condition may develop gradually over months or years before being recognized. Because hormone production is impaired, normal regulation of metabolism, blood pressure, and fluid balance can be disrupted.

Symptoms and signs of Addison’s disease are often nonspecific and may include fatigue, weakness, weight loss, loss of appetite, and gastrointestinal complaints such as abdominal pain, nausea, or vomiting. People may also experience dizziness or lightheadedness, particularly when standing, due to low blood pressure and impaired vascular tone. Other features can include skin changes such as hyperpigmentation, which is more typical of primary adrenal insufficiency, and may reflect altered hormone processing. In some cases, the illness can present with electrolyte abnormalities, including low sodium and high potassium, which can contribute to symptoms like muscle weakness or abnormal heart rhythms. Under stress, symptoms can worsen rapidly and progress to Addisonian crisis, a life-threatening state characterized by severe hypotension and impaired consciousness.

Historically, Addison’s disease was first described in the 19th century by Thomas Addison, who linked characteristic clinical features to adrenal gland damage found at autopsy. Over time, medical understanding expanded from clinical observation to recognition of adrenal hormone physiology and the distinction between primary and secondary or tertiary adrenal insufficiency. Primary adrenal insufficiency is contrasted with secondary adrenal insufficiency caused by reduced ACTH from the pituitary, and tertiary adrenal insufficiency caused by reduced CRH from the hypothalamus. The term “Addisonian crisis” has been used for the acute decompensation that can occur when cortisol levels are critically low, regardless of the underlying type of adrenal insufficiency. Epidemiologically, autoimmune causes are common in many regions, while infectious causes vary by geography and historical exposure patterns.

Artist: JOHN. Credit: Own work. License: CC BY-SA 4.0. Source: Wikimedia Commons file page.

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