Feeling unusually tired, losing weight without trying, or getting dizzy when you stand up? Those could be more than just stress — they can be signs of Addison's disease, a condition where your adrenal glands don't make enough cortisol (and sometimes aldosterone). It sounds rare, but knowing what to watch for and how treatment works can make a big difference.
Symptoms often come on slowly. Common ones are constant fatigue, muscle weakness, low appetite, and unexplained weight loss. Skin darkening or tan lines in unusual places is a classic clue for primary Addison's. You might notice low blood pressure, lightheadedness when you stand, or salt cravings — those come from low aldosterone. Nausea, vomiting, and depression or brain fog are also common. If you have autoimmune conditions or a history of TB or adrenal injury, your risk goes up.
There’s also the adrenal crisis — that’s an emergency. Signs include severe weakness, vomiting, very low blood pressure, confusion, and sometimes fever. If someone with Addison's becomes severely ill or can't keep down fluids, they can go into crisis fast. Emergency treatment is life-saving, so know the red flags.
Doctors check blood cortisol and ACTH levels and look at electrolytes. Low sodium and high potassium point toward primary adrenal failure. The ACTH stimulation test (short synacthen test) is the standard: cortisol is measured before and after a synthetic ACTH injection to see if the adrenals respond. Sometimes imaging like an abdominal CT or pituitary MRI is needed to find the cause.
Other useful checks include thyroid tests, blood sugar, and screening for autoimmune antibodies. Getting an accurate diagnosis matters because treatment is straightforward and effective once started.
Treatment replaces the missing hormones. Hydrocortisone is the usual cortisol replacement taken in split daily doses to mimic natural rhythms. Some people use prednisone. If aldosterone is low, doctors add fludrocortisone to help control blood pressure and salts. Doses are individualized and adjusted based on symptoms, blood pressure, weight, and lab results.
Simple daily rules help prevent problems: never skip medication, increase glucocorticoid dose during fever or stress (sick day rules), carry an emergency steroid injection kit if advised, and wear a medical alert bracelet or card. Keep snacks or salty drinks handy if you feel lightheaded. Regular follow-ups and learning how to inject emergency hydrocortisone can keep you safe.
Living with Addison's is manageable with the right treatment plan. If you notice worrying symptoms or have a family history of autoimmune disease, ask your doctor about testing. Quick action during illness and consistent replacement therapy let most people lead full, active lives.
