The essentials

Addison's disease is a rare condition in which the adrenal glands do not make enough hormones, mainly cortisol and aldosterone. It causes tiredness, weight loss, low blood pressure and sometimes darker skin. Blood tests can show low sodium, high potassium and low cortisol, and a stimulation test confirms the diagnosis. Treatment replaces the missing hormones for life. A sudden worsening, called an adrenal crisis, is an emergency.

What is Addison's disease, at a glance?

  • What happens: the outer layer of the adrenal glands is damaged, so the body lacks glucocorticoids such as cortisol and mineralocorticoids such as aldosterone[2].
  • Usual cause: an autoimmune attack on the adrenal glands[2].
  • Key blood tests: sodium, potassium, morning cortisol and ACTH, then a cosyntropin (ACTH) stimulation test[1][2].
  • Cause check: antibodies against 21-hydroxylase, an adrenal enzyme[1][4].
  • Treatment: lifelong hormone replacement; with it, many people live a nearly normal life[2].

What are the symptoms of Addison's disease?

The symptoms often come on slowly and can come and go. They tend to get worse during an infection or other stress[2].

  • Most common: extreme tiredness and weakness, loss of appetite, weight loss and abdominal pain[2][3][5].
  • Digestive: nausea, vomiting and chronic diarrhea[2].
  • Blood pressure and sugar: low blood pressure, dizziness when standing up, and low blood sugar[2].
  • Skin and salt: darkening of the skin and a craving for salt[2].

Because these signs are vague, the diagnosis is often delayed. Doctors are advised to test for adrenal insufficiency in anyone with indicative symptoms, to have a low threshold when a person is acutely ill, and to think of it in pregnant women with unexplained persistent nausea, fatigue and low blood pressure[1].

When should I see a doctor?

When to see a doctor

  • Emergency: call 911 for severe abdominal pain, vomiting, trouble breathing, severe dizziness or fainting, confusion or a drop in alertness, especially if you have Addison's disease or take steroid medicine. These are signs of an adrenal crisis, which needs an immediate hydrocortisone injection[2].
  • Within 24 to 48 hours for repeated vomiting or diarrhea, a fever or an infection if you already have Addison's disease (your doses may need to be raised), or for new dizziness on standing with weakness[2].
  • At your next appointment for weeks of unexplained tiredness, weight loss, poor appetite, darker skin or salt craving[2][3].

What causes Addison's disease?

The damage to the adrenal cortex has several possible causes[2].

  • Common An autoimmune attack on the adrenal glands. It is linked to other autoimmune diseases, such as type 1 diabetes, Graves disease and vitiligo[2].
  • Possible Infections such as tuberculosis, HIV or fungal infections[2].
  • Possible Bleeding into the glands, or tumors[2].
  • Rare Inherited genetic defects[2].

A related problem, adrenal insufficiency, can also follow the abrupt stopping of steroid medicines taken for other conditions[3]. Never stop a steroid on your own.

Which blood tests diagnose Addison's disease?

Routine blood tests can give the first clue. Potassium may be high, sodium low and cortisol low, DHEA is low and eosinophils may be high[2]. Here is a fictitious report.

Fictitious example of a lab report line (United States format)
TestResultReference rangeFlag
Sodium129 mmol/L135-145 mmol/LL
Potassium5.7 mmol/L3.5-5.1 mmol/LH
Glucose (fasting)62 mg/dL70-99 mg/dLL
Cortisol, 8 a.m.2.4 µg/dL6-19 µg/dLL
ACTH, 8 a.m.180 pg/mL7-63 pg/mLH
  1. Sodium and potassium: low sodium and high potassium are typical of a lack of aldosterone[2].
  2. Glucose: low blood sugar is a known symptom of the disease[2].
  3. Cortisol and ACTH: guidelines advise measuring morning plasma ACTH and cortisol when a stimulation test is not possible first[1]. A low cortisol with a high ACTH points to the adrenal glands themselves. Ranges shown are typical examples: your laboratory's range prevails.

Got sodium, potassium or cortisol results you do not understand? BloodSense explains each line of your complete report and helps you prepare your questions for your endocrinologist.

Get my hormone results explained

How do doctors confirm the diagnosis?

The Endocrine Society guideline calls the short corticotropin (cosyntropin) test the gold standard to establish the diagnosis[1]. Blood cortisol is measured before and after an injection of a synthetic ACTH, to see whether the adrenal glands respond[1][2]. To find the cause, a validated test for antibodies against 21-hydroxylase is recommended; if they are negative, other causes should be looked for[1]. Imaging of the adrenal glands by CT or MRI can help find the cause[2][3]. See also our guide to the cortisol blood test, ACTH and aldosterone.

How is Addison's disease treated?

Treatment replaces the missing hormones for life: a glucocorticoid (such as hydrocortisone) and, in most people, a mineralocorticoid[1][2]. No doses are given here: your doctor sets them.

  • Stress doses: doses are raised temporarily during an infection, an injury or surgery[2][3].
  • Never skip a dose: life-threatening reactions may occur[2].
  • Safety kit: patients should be taught about stress dosing, carry a steroid card and have a hydrocortisone preparation for emergency injection[1][2].
  • Diet: some people need a high-sodium diet, and those on cortisol replacement need enough calcium and vitamin D[3].

How is Addison's disease followed over time?

Follow-up aims to check that the dose is right and to watch for associated autoimmune diseases, particularly autoimmune thyroid disease[1]. Your doctor may repeat blood tests such as sodium and potassium and check your thyroid. With treatment, many people lead a nearly normal life[2].

Can Addison's disease be prevented, and how do I live with it?

An autoimmune adrenal attack cannot be prevented. What you can do is avoid a crisis[1][2].

  • Take your hormone replacement every day and never skip a dose[2].
  • Learn how to raise your doses when you are sick, injured or having surgery, and ask your doctor for a written plan[1][3].
  • Carry a steroid card or medical ID, and keep an emergency hydrocortisone injection with you if your doctor has prescribed it[1][2].
  • Tell every doctor, dentist and emergency team that you have adrenal insufficiency before any procedure.
  • Do not stop steroid medicines taken for other conditions without medical advice[3].
  • Keep your follow-up visits, including thyroid checks[1].

Questions to ask your doctor

  1. Which tests do I need to confirm adrenal insufficiency, and why this one?
  2. Do I have antibodies against 21-hydroxylase, and what does this mean for other autoimmune diseases?
  3. How should I change my doses when I am sick or injured?
  4. Do I need a steroid card and an emergency injection kit, and who can give it?
  5. How often should my blood tests and my thyroid be checked?

Frequently asked questions

Is Addison's disease the same as adrenal insufficiency?

Addison's disease is primary adrenal insufficiency, caused by damage to the adrenal glands themselves[1][2].

Can a normal blood test rule out Addison's disease?

No. Routine tests can be normal, and the stimulation test is the gold standard when the disease is suspected[1].

Why does Addison's disease darken the skin?

Skin darkening is one of its recognized symptoms[2].

Is Addison's disease curable?

No, but replacement therapy allows many people to live a nearly normal life[2].

What is an adrenal crisis?

It is an extreme form of adrenal insufficiency with abdominal pain, trouble breathing, dizziness, low blood pressure and reduced consciousness. It requires an immediate hydrocortisone injection[2].

  1. Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(2):364-389. doi:10.1210/jc.2015-1710 (accessed October 24, 2026)
  2. MedlinePlus Medical Encyclopedia. Addison disease. Reviewed April 24, 2025. US National Library of Medicine. medlineplus.gov (accessed October 24, 2026)
  3. National Institute of Diabetes and Digestive and Kidney Diseases. Adrenal insufficiency and Addison's disease. Last reviewed September 2018. National Institutes of Health. niddk.nih.gov (accessed October 24, 2026)
  4. Husebye ES, Allolio B, Arlt W, et al. Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency. J Intern Med. 2014;275(2):104-115. doi:10.1111/joim.12162 (accessed October 24, 2026)
  5. Husebye ES, Pearce SH, Krone NP, Kämpe O. Adrenal insufficiency. Lancet. 2021;397(10274):613-629. doi:10.1016/S0140-6736(21)00136-7 (accessed October 24, 2026)

This page is general information. It does not replace the advice of a doctor, who interprets your results with your symptoms, history and examination.