What Causes Addison’s Disease – And How To Manage It
Exactly what causes Addison’s disease is unknown, as with most autoimmune conditions. Addison’s disease is a rare disorder that affects the body’s ability to produce cortisol and aldosterone hormones. It occurs when the outer layer of the adrenal gland, known as the adrenal cortex, is damaged, typically by an autoimmune reaction, but can also result from an infection, or another health problem.1 2
What Is Cortisol?
Cortisol is a hormone that is released by the adrenal glands in response to stress. It plays an important role in regulating many of our body’s processes, including metabolism, immunity, blood pressure, and heart rate. Cortisol also helps regulate glucose levels, supplying energy for activity when it is needed most.3
When cortisol levels are too high, it can lead to a variety of health issues such as obesity, hypertension, depression, and insomnia. On the other hand, when cortisol levels are too low, it can lead to adrenal insufficiency or Addison’s disease.
Without enough cortisol, which helps regulate metabolism and the body’s response to stress, people with Addison’s disease may experience symptoms such as extreme fatigue, low blood pressure, weight loss, muscle weakness, abdominal pain, or nausea.4
What Is Aldosterone?
Aldosterone is a steroid hormone that is produced by the outer layer of the adrenal cortex, which is located on top of each kidney. It plays an important role in maintaining proper electrolyte balance and regulating blood pressure. Aldosterone helps to reabsorb sodium ions from the urine and conserve potassium in the body.
In addition, it stimulates the release of bicarbonate, which helps to maintain an alkaline pH balance in the blood. Aldosterone is also involved in promoting water reabsorption from the kidneys and increasing blood volume. By controlling salt and water balance, aldosterone helps regulate blood pressure throughout the body.5
High levels of aldosterone may lead to hypertension or high blood pressure. Too much aldosterone can cause the body to retain sodium and water, resulting in an increase in blood volume and an elevation of blood pressure. On the other hand, in the case of Addison’s disease, low levels of aldosterone lead to hypotension or low blood pressure.6
Primary Adrenal Insufficiency – Adrenal Gland Damage
Primary adrenal insufficiency is caused by damage to the adrenal glands, particularly in the outer layer called the cortex. The damage is often due to autoimmune diseases, infections like tuberculosis and HIV, tumors, or trauma.7
Read more about autoimmune diseases.
Secondary Adrenal Insufficiency
Secondary Adrenal Insufficiency, also known as acquired adrenal insufficiency, occurs when the pituitary gland doesn’t produce enough of the hormones that stimulate the adrenal glands. Secondary Adrenal Insufficiency is usually a result of damage to or disruption of the hypothalamic-pituitary-adrenal axis (HPA axis). This can be caused by medications, infections, tumors, or other medical conditions that affect the HPA axis.
The most common causes of Secondary Adrenal Insufficiency are from long-term use of corticosteroids, pituitary gland disorders such as Sheehan syndrome (postpartum pituitary necrosis), inadequate replacement of cortisol, and pituitary tumors or surgery. Other rare causes can include HIV/AIDS, autoimmune disorders, certain genetic conditions, and head trauma.8
Addison’s Disease Has A Genetic Component
Addison’s disease is more common in people who have a family history of autoimmune diseases or those with certain genetic conditions, such as familial glucocorticoid deficiency. A 2021 study has shown that people with Addison’s Disease have an inherited gene mutation that is linked to the condition.9
Addison’s Disease Is Also Linked To Environmental Factors
Environmental factors such as exposure to certain bacteria or viruses also play a role in Addison’s Disease. Some people with Addison’s Disease have been found to have developed antibodies directed against their own adrenal tissue. This suggests that a previous infection may have sparked the immune system to attack the adrenal glands.10
Treating Addison’s Disease
The treatment for Addison’s disease primarily consists of hormone replacement therapy with glucocorticoids and mineralocorticoids. The goal of hormone replacement therapy is to replace the hormones that are missing or not being produced properly in the body. Glucocorticoids, such as hydrocortisone, work to replace the cortisol that is not being adequately produced. Mineralocorticoids, such as fludrocortisone, help to regulate sodium and potassium levels in the body and maintain blood pressure.11
These medications need to be taken regularly for life in order to manage symptoms of Addison’s disease and prevent flare-ups. Additionally, it is important to note that glucocorticoid and mineralocorticoid doses need to be monitored regularly to ensure they are at an appropriate level for each individual.
In addition to hormone replacement therapy, lifestyle modifications may also be necessary in order to manage symptoms of Addison’s disease. This includes avoiding activities and environments that can be stressful, eating a balanced diet, and regular exercise. It is also important to maintain a normal sleep schedule and to avoid caffeine, tobacco, or alcohol as these can interfere with hormone replacement therapy.
What Is An Addisonian Crisis?
An Addisonian crisis, also known as an Addisonian emergency or adrenal crisis, is a life-threatening condition that occurs when there is an acute deficiency of cortisol and other hormones produced by the adrenal glands. Common symptoms of an Addisonian crisis include abdominal pain, nausea, dehydration, low blood pressure, changes in mental state like confusion and disorientation, as well as hypoglycemia. If not recognized and treated quickly, an Addisonian crisis can lead to shock, coma, and death. Treatment of an Addisonian crisis involves immediate administration of intravenous fluids and hormonal replacement therapy.12
Addison’s Disease And Stress
Addison’s disease and stress can be a difficult combination for many people. People with Addison’s disease typically have an increased sensitivity to the body’s stress response, which can lead to more intense symptoms during periods of elevated stress. Common signs of distress due to this increased sensitivity include fatigue, anxiety, headaches, mood swings, low blood pressure, and changes in appetite or weight.13
Addison’s Disease And Sleep
Addison’s disease is an endocrine disorder that can affect sleep. People with Addison’s disease often report difficulty sleeping or feeling excessively sleepy during the day. They may also have trouble staying asleep throughout the night and feel groggy and unfocused when they wake up in the morning. Poor quality of sleep can have a negative impact on overall health and well-being.
Research has found that people with Addison’s disease may have a higher prevalence of difficulty sleeping and insomnia than those without the condition. In addition, research suggests that untreated adrenal insufficiency can lead to longer sleep times, more frequent awakenings, and fragmentation of sleep.14
Addison’s Disease And Alcohol Consumption
For people with Addison’s Disease, drinking alcohol can be especially dangerous. Excessive alcohol consumption puts stress on the adrenal glands, which can lead to a worsening of symptoms and other medical complications.
People with Addison’s Disease should avoid alcohol altogether or limit themselves to only an occasional glass of wine or beer. Even moderate alcohol consumption can be problematic for those with Addison’s Disease, as it can cause an electrolyte imbalance. This can lead to low blood pressure, dehydration, and fatigue.15
The Link Between Addison’s Disease And Thyroid Disease
Addison’s disease and thyroid disease are two conditions that often occur together. Thyroid disease is caused by an overproduction or underproduction of hormones produced by the thyroid gland. This can lead to either weight gain or loss, fatigue, and other symptoms.
The two conditions often occur together because they are connected in various ways. In fact, one 2022 study found that 48% of people with Addison’s Disease also had autoimmune thyroid disease.16 It is important for those with Addison’s Disease to be aware of their risk for thyroid disease.
Read more about thyroid disease.
What Causes Addison’s Disease – And How To Manage It
In addition to glucocorticoid and mineralocorticoid hormone replacement therapy, there are some natural approaches that can help manage Addison’s Disease.
First, get regular exercise. Exercise is essential for people with Addison’s Disease because it helps manage stress. Regular, moderate exercise can help improve energy levels and physical functioning. Second, eat a healthy diet. Eating a nutrient-rich diet like my Cellular Healing Diet can help manage Addison’s Disease. Avoid processed foods, added sugars, and unhealthy fats since they increase inflammation in the body.
Read more about the Cellular Healing Diet.
The Link Between Addison’s Disease And Low Vitamin D Levels
Research has shown that individuals with Addison’s disease suffer from low levels of vitamin D. Vitamin D is a fat-soluble vitamin that plays an important role in maintaining proper bone health and immune system function. Low levels of vitamin D can lead to weakened bones, increased risk for infections, and a lowered immune response.17
Read more about the role vitamin D plays in autoimmune conditions.
Manage stress and get plenty of rest. High levels of stress can worsen symptoms of Addison’s Disease. Finding healthy ways to manage stress such as yoga, meditation, and breathing exercises is ideal. Lack of sleep can also worsen Addison’s Disease symptoms, so make sure to get enough restful sleep each night.18
Read more about chronic fatigue syndrome.
References
1 Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet. 2014;383(9935):2152–2167.
2 Barthel A, Benker G, Berens K, Diederich S, Manfras B, Gruber M, Kanczkowski W, Kline G, Kamvissi-Lorenz V, Hahner S, Beuschlein F, Brennand A, Boehm BO, Torpy DJ, Bornstein SR. An Update on Addison’s Disease. Exp Clin Endocrinol Diabetes. 2019 Feb;127(2-03):165-175. doi: 10.1055/a-0804-2715. Epub 2018 Dec 18. PMID: 30562824.
3 What Is Cortisol? (2017, February 5). WebMD. https://www.webmd.com/a-to-z-guides/what-is-cortisol
4 Addison’s disease – Diagnosis and treatment – Mayo Clinic. (2022, December 8). https://www.mayoclinic.org/diseases-conditions/addisons-disease/diagnosis-treatment/drc-20350296
5 Professional, C. C. M. (2023). Aldosterone. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/24158-aldosterone
6 Munir S, Quintanilla Rodriguez BS, Waseem M. Addison Disease. 2022 Aug 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 28723023.
7 Alexandraki KI, Sanpawithayakul K, Grossman A. Adrenal Insufficiency. [Updated 2022 Nov 7]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279083/
8 Grossman, A. B. (2023, May 18). Secondary Adrenal Insufficiency. Merck Manuals Professional Edition. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/adrenal-disorders/secondary-adrenal-insufficiency
9 Røyrvik EC, Husebye ES. The genetics of autoimmune Addison disease: past, present and future. Nat Rev Endocrinol. 2022 Jul;18(7):399-412. doi: 10.1038/s41574-022-00653-y. Epub 2022 Apr 11. PMID: 35411072.
10 Hellesen A, Bratland E. The potential role for infections in the pathogenesis of autoimmune Addison’s disease. Clin Exp Immunol. 2019 Jan;195(1):52-63. doi: 10.1111/cei.13207. Epub 2018 Sep 30. PMID: 30144040; PMCID: PMC6300649.
11 Quinkler M. Morbus Addison [Addison’s disease]. Med Klin Intensivmed Notfmed. 2012 Sep;107(6):454-9. German. doi: 10.1007/s00063-012-0112-3. Epub 2012 Aug 22. PMID: 22907517.
12 Rathbun KM, Nguyen M, Singhal M. Addisonian Crisis. [Updated 2023 Feb 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441933/
13 Warmuz-Stangierska I, Baszko-Błaszyk D, Sowiński J. Emotions and features of temperament in patients with Addison’s disease. Endokrynol Pol. 2010 Jan-Feb;61(1):90-2. PMID: 20205110.
14 Henry M, Thomas KGF, Ross IL. Sleep, Cognition and Cortisol in Addison’s Disease: A Mechanistic Relationship. Front Endocrinol (Lausanne). 2021 Aug 27;12:694046. doi: 10.3389/fendo.2021.694046. PMID: 34512546; PMCID: PMC8429905.
15 Abdalla M, Dave JA, Ross IL. Addison’s disease associated with hypokalemia: a case report. J Med Case Rep. 2021 Mar 25;15(1):131. doi: 10.1186/s13256-021-02724-6. PMID: 33761983; PMCID: PMC7992934.
16 Meling Stokland AE, Ueland G, Lima K, Grønning K, Finnes TE, Svendsen M, Ewa Tomkowicz A, Emblem Holte S, Therese Sollid S, Debowska A, Singsås H, Landsverk Rensvik M, Lejon H, Sørmo DE, Svare A, Blika S, Milova P, Korsgaard E, Husby Ø, Breivik L, Jørgensen AP, Sverre Husebye E. Autoimmune Thyroid Disorders in Autoimmune Addison Disease. J Clin Endocrinol Metab. 2022 May 17;107(6):e2331-e2338. doi: 10.1210/clinem/dgac089. PMID: 35226748; PMCID: PMC9113809.
17 Penna-Martinez M, Meyer G, Wolff AB, Skinningsrud B, Betterle C, Falorni A, Ollier W, Undlien D, Husebye E, Pearce S, Mitchell AL, Badenhoop K. Vitamin D status and pathway genes in five European autoimmune Addison’s disease cohorts. Eur J Endocrinol. 2021 Mar;184(3):373-381. doi: 10.1530/EJE-20-0956. PMID: 33444227.
18 Henry M, Ross IL, Wolf PSA, Thomas KGF. Impaired quality and efficiency of sleep impairs cognitive functioning in Addison’s disease. Psychoneuroendocrinology. 2017 Apr;78:237-245. doi: 10.1016/j.psyneuen.2017.02.004. Epub 2017 Feb 11. PMID: 28235729.
