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Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, eds. Williams Textbook of Endocrinology. 10th ed. Philadelphia, PA:Elsevier Saunders; 2003:525-527.
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Gurnell EM, Hunt PJ, Curran SE, et al. Long-term DHEA replacement in primary adrenal insufficiency: a randomized, controlled trial. J Clin Endocrinol Metab. 2008;93:400-409.
Anglin RE, Rosebush PI, Mazurek MF. The neurophsychiatric profile of Addison’s disease: revisiting a forgotten phenomenon. J Neuropsychiatric Clin Neurosci. 2006;18:450-459.
Kowal BF, Turco J, Nangia AK. Addison’s disease presenting as male infertility. Fertil Steril. 2006;85:1059:e1-4.
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INTERNET
Griffing GT, Odeke S, Nagelberg SB. Addison Disease. Medscape. //emedicine.medscape.com/article/116467-overview Updated: Mar 23, 2017. Accessed January 2, 2018.
National Endocrine and Metabolic Diseases Information Service. Adrenal Insufficiency and Addison’s Disease. //endocrine.niddk.nih.gov/pubs/addison/addison.aspx Updated May 14, 2014. Accessed January 2, 2018.
Mayo Clinic for Medical Education and Research. Addison’s disease. //www.mayoclinic.com/health/addisons-disease/DS00361 Updated Aug. 04, 2017. Accessed January 2, 2018.
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Medically reviewed by Xixi Luo, M.D. — By Tim Newman on August 15, 2017
Treatment of Addison’s disease generally involves corticosteroid replacement therapy. The medications are taken for life. The corticosteroid medication, which is usually taken orally (by mouth), replaces the cortisol and aldosterone the body is not producing.
Treatment options for Addison’s disease include many medications, usually in the form of tablets, depending on the specific hormones that the body is missing.
The outlook is positive if the corticosteroid replacement therapy is maintained – it is vital that patients follow the doctor’s instructions.
Share on PinterestAddison’s disease affects the adrenal glands.
The drugs required to effectively treat Addison’s depends on the hormones that are no longer being effectively produced in the adrenal glands.
Some potential medications include the following:
- Hydrocortisone – these tablets replace the missing cortisol. Prednisolone or dexamethasone are prescribed less commonly.
- Fludrocortisone – might be prescribed for missing aldosterone.
- Dehydroepiandrosterone (DHEA) – these pills may be prescribed if there is an androgen (the male sex hormone) deficiency.
Medication side effects
Side effects of hydrocortisone and fludrocortisone: include sleep problems, acne, slow wound healing, dizziness, nausea, and increased sweating.
Side effects of DHEA in women: similar to above but may also include changes in menstrual cycle, developing a deeper voice, and facial hair growth.
The frequency a patient has to take medication depends on their level of hormone deficiency and the severity of their symptoms. As a result, patients will have their treatment program tweaked by a healthcare professional over time.
Because the condition is treated with medications that need to be taken for the rest of a patient’s life, there are several risk factors that need to be considered.
Caution must be exercised when the person with Addison’s disease experiences the following:
- Illness – if the patient becomes unwell, their hormonal levels may be impacted, meaning that their medications may be less effective in alleviating symptoms.
- Surgery – a dysfunction of the adrenal gland is an important consideration during surgery; patients will need to be carefully monitored and have their treatment adjusted during and when recovering from surgery.
- Pregnancy – if a patient becomes pregnant, hormone levels change. During pregnancy, medications may have to be adjusted regularly to be effective.
During times of stress, injury, or infection medication may need to be increased. If the patient suffers from vomiting, the medications might need to be injected.
The patient may also have to add extra salt to their daily diet.
Adrenal crisis is a life-threatening situation where blood pressure and blood glucose levels are dangerously low, and potassium levels are too high.
The patient will require emergency medical treatment, which usually involves intravenous injections of:
- hydrocortisone
- saline solution
- sugar (dextrose)
Adrenal crisis is an emergency and should be treated immediately.
Medical alert bracelet/necklace
Many doctors advise patients to wear a medical alert bracelet or necklace that informs healthcare professionals that they have Addison’s disease; this is especially important for older patients who may be more likely to fall or injure themselves.
Addison’s disease patients do not produce enough cortisol, so when they have an accident or serious injury, medical staff need to know what medication the individual immediately requires (cortisol) to prevent any complications.
Read more about Addison’s disease:
Last medically reviewed on August 15, 2017
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- Addison's disease - Treatment. (2017)
//www.nhs.uk/conditions/addisons-disease/Pages/Treatment.aspx - Giordano, R., Guaraldi, F., Marinazzo, E., Fumarola, F., Rampino, A., Berardelli, R., ... & Arvat, E. (2016). Improvement of anthropometric and metabolic parameters, and quality of life following treatment with dual-release hydrocortisone in patients with Addison's disease. Endocrine, 51(2), 360-368
//europepmc.org/abstract/med/26184416 - Napier, C., Gan, E. H., Mitchell, A. L., & Pearce, S. H. (2016). Brief Therapeutic Window of Steroidogenic Potential in Newly Diagnosed Autoimmune Addison's Disease. In Cushing Syndrome and Primary Adrenal Disorders</em (pp. OR25-3). Endocrine Society
//press.endocrine.org/doi/abs/10.1210/endo-meetings.2016.AHPAA.9.OR25-3 - Puar, T. H., Stikkelbroeck, N. M., Smans, L. C., Zelissen, P. M., & Hermus, A. R. (2016). Adrenal crisis: still a deadly event in the 21 st century. The American journal of medicine, 129(3), 339-e1
//www.sciencedirect.com/science/article/pii/S000293431500827X
Your doctor will prescribe hormone medicines to replace the hormones that your adrenal glands aren’t making. You’ll need higher doses during times of physical stress.
Hormone replacement
Cortisol is replaced with a corticosteroid, most often hydrocortisone, which you take two or three times a day by mouth. Less often, doctors prescribe prednisone or dexamethasone.
If your adrenal glands aren’t making aldosterone, you will take a medicine called fludrocortisone, which helps balance the amount of sodium and fluids in your body. People with secondary adrenal insufficiency usually make enough aldosterone, so they don’t need to take this medicine.
Your doctor will adjust the dose of each medicine to meet your body’s needs.
Treatment for adrenal crisis includes immediate IV injections of corticosteroids and large amounts of IV saline, a salt solution, with dextrose added. Dextrose is a type of sugar.
Treatment in special situations
Surgery
If you’re having any type of surgery that uses general anesthesia, you may have treatment with IV corticosteroids and saline. IV treatment begins before surgery and continues until you’re fully awake after surgery and can take medicine by mouth. Your doctor will adjust the “stress” dose as you recover until you’re back to your pre-surgery dose.
Illness
Talk with your doctor about how to adjust your dose of corticosteroids during an illness. You will need to increase your dose if you have a high fever. Once you recover, your doctor will adjust your dose back to your regular, pre-illness level. You will need immediate medical attention if you have a severe infection or diarrhea, or are vomiting and can’t keep your corticosteroid pills down. Without treatment, in an emergency room if necessary, these conditions can lead to an adrenal crisis.
Injury or other serious condition
If you have a severe injury, you may need a higher, “stress” dose of corticosteroids right after the injury and while you recover. The same is true if you have a serious health condition such as suddenly passing out or being in a coma. Often, you must get these stress doses intravenously. Once you recover, your doctor will adjust your dose back to regular, pre-injury level.
Pregnancy
If you become pregnant and have adrenal insufficiency, you’ll take the same dose of medicine as you did before pregnancy. However, if nausea and vomiting in early pregnancy make it hard to take medicine by mouth, your doctor may need to give you corticosteroid shots. During delivery, treatment is similar to that of people needing surgery. Following delivery, your doctor will slowly decrease your dose, and you’ll be back to your regular dose about 10 days after your baby is born.