Addison’s Disease: Hormone Replacement, Diagnosis and Adrenal Crisis

Addison’s disease is primary adrenal insufficiency: damage to the adrenal glands prevents them from producing enough cortisol and, in some people, aldosterone. The adrenal glands sit above the kidneys. Cortisol supports essential functions, including the response to physical stress; aldosterone helps regulate salt, fluid balance and blood pressure.

Not all adrenal insufficiency is Addison’s disease

Adrenal insufficiency can also result from problems in the hormonal signals from the pituitary or hypothalamus. Suppression following prolonged corticosteroid treatment is another important cause. These conditions can share symptoms but are not interchangeable diagnoses. The NIDDK explanation of adrenal insufficiency distinguishes the different forms.

Symptoms and causes

Possible symptoms include persistent fatigue, muscle weakness, reduced appetite, weight loss, abdominal discomfort and dizziness on standing. Skin darkening and salt craving can occur. Symptoms may develop gradually and overlap with many other conditions.

Autoimmune damage is one cause of Addison’s disease. Infections, including tuberculosis, and other forms of adrenal damage can also cause it. A clinician investigates the cause rather than assuming every case is autoimmune. Read the NIDDK symptoms and causes guide.

Diagnosis requires appropriate hormone testing

Assessment combines the clinical history with blood testing. An ACTH stimulation test measures the cortisol response to a hormone signal. Additional hormone, antibody or imaging tests may help identify the type and cause. Test selection and interpretation belong with the treating team; a symptom checklist cannot confirm the condition. The NIDDK diagnostic guide explains these investigations.

Replacing hormones is essential treatment

Cortisol is replaced with prescribed glucocorticoid medicine, commonly hydrocortisone. Fludrocortisone may be needed when aldosterone is deficient. Treatment is usually lifelong in Addison’s disease. The dose and schedule must be individualised.

Illness, injury or surgery may require a different steroid dose. Ask for written “sick-day” instructions, an emergency plan and advice about a medical alert card or bracelet. Arrange emergency-injection training and supplies with the team. Do not suddenly stop prescribed replacement steroids. The NIDDK treatment guide explains why these precautions matter.

Recognising an adrenal crisis

Adrenal crisis is a medical emergency. Severe weakness, vomiting, severe abdominal pain, marked dizziness, confusion or collapse in someone with adrenal insufficiency requires urgent action. Inability to keep steroid tablets down needs immediate medical advice and the prescribed emergency plan. If a crisis is suspected, call emergency services; give the prescribed emergency injection if you or your carer have been trained, and still obtain emergency care. Do not wait to see whether the injection is enough. See the NHS Addison’s disease guide.

“Adrenal fatigue” is a different claim

The Endocrine Society states that “adrenal fatigue” lacks scientific evidence as a medical diagnosis. Persistent symptoms deserve proper investigation; unproven supplements do not replace prescribed hormone treatment.

Practical appointment checklist

1. Keep prescribed replacement medicine available and avoid running out.
2. Obtain written sick-day instructions from the treating team.
3. Check emergency supplies and arrange injection training for an appropriate helper.
4. Carry medical alert information and the emergency contact plan.

Keep your next steps together

Use our appointment preparation guide and resources to organise questions and support. Ask the treating team to confirm the plan in writing.

Finding support in South Africa

Rare Diseases South Africa provides patient resources and routes to support. Confirm available services with the organisation and discuss specialist referrals with your treating clinician. Our appointment preparation guide can help you organise reports and questions.

Sources checked on 17 September 2026. This is general educational information, not an individual diagnosis or treatment plan. International guidance may describe tests, medicines or services that differ from those available in South Africa. Discuss your own care with a qualified healthcare professional. The featured image is an AI-generated illustration, not a photograph of a real patient.