The adrenal glands, on top of the kidneys, produce an anti-inflammatory hormone called cortisol, which also plays an important role in the stress response and in making energy from food. Around 9,000 Americans have a chronic condition called Addison’s disease, in which the adrenal glands fail to produce cortisol, leading to problems with metabolism and inflammation. Although Addison’s disease can be life-threatening, it’s not difficult for patients to lead normal lives with proper care.
There are two basic types of Addison’s disease, called primary and secondary adrenal insufficiency. Primary insufficiency refers to a defect in the adrenal gland itself; secondary insufficiency is a defect in other parts of the body that affect the adrenal glands. A major cause of the disease—70 percent of cases—is an autoimmune response, in which the immune system mistakenly attacks the adrenal glands. People who have other autoimmune conditions are particularly likely to have Addison’s disease. Conditions such as tuberculosis, HIV infection, and some types of cancer can also damage the adrenal glands.
Symptoms are gradual, starting with fatigue and weakness. Addison’s patients also have poor appetite and weight loss. Less common symptoms include nausea and vomiting, diarrhea, low blood sugar, and salt cravings. Unexplained darkening of the skin is a symptom the requires urgent care. The disease is typically diagnosed with blood tests or imaging tests. There is no cure for Addison’s disease. Corticosteroids are sometimes used to treat it, though in some cases they can also exacerbate the condition. It is generally recommended that patients get plenty of salt.
In recent years, doctors have become more aware of the risks posed by untreated Addison’s disease. At one extreme, the back brace worn by President John F. Kennedy to help him with back pain due to adrenal insufficiency has been speculated to have kept him in the path of an assassin’s bullet. Most people have more prosaic complications, however. For many patients, lack of cortisol leaves them vulnerable to infections; these infections, in turn, can trigger an acute attack called an Addisonian crisis. Addisonian crisis requires emergency medical treatment, and can be life-threatening, with symptoms including vomiting, fainting, and psychosis.