Addison’s Disease

What is Addison's Disease?

Addison's disease is a condition in which the outer layer of the adrenal glands is destroyed, so the body makes too little cortisol, aldosterone and related hormones.^[1] It is the most common cause of primary adrenal insufficiency in adults and is usually caused by an immune attack on the adrenal glands.^[2] It is rare and can become a life-threatening emergency.^[1]

Common symptoms

Symptoms are often vague and come on slowly, which is why diagnosis is frequently delayed.^{[1, 2]} Across adrenal insufficiency, fatigue is reported by roughly half to nearly all patients, nausea and vomiting by a fifth to three fifths, and poor appetite with weight loss by a large share.^[3]

Other signs include low blood pressure, salt craving and darkening of the skin, which are standard features of the disease.^[1] An adrenal crisis can bring low blood pressure and shock, dangerously low sodium, confusion and death if not treated.^[3]

Causes and risk factors

Autoimmune destruction of the adrenal cortex is the most common cause, and tests often find antibodies to an adrenal enzyme called 21-hydroxylase.^{[1, 4]} Other causes of primary adrenal insufficiency include tuberculosis and other infections, certain antifungal drugs at high doses, surgical removal of adrenal tissue and congenital adrenal hyperplasia.^[3] Autoimmune thyroid disease is a common companion condition, so follow-up includes watching for it.^[4]

How it is diagnosed and treated conventionally

Diagnosis rests on blood tests showing low cortisol with high ACTH, and a short corticotropin (ACTH) stimulation test is the usual gold standard.^{[1, 4]} Antibody testing then looks for the autoimmune cause.^[4]

Treatment is lifelong replacement with hydrocortisone or a similar steroid plus fludrocortisone, with patients taught to raise their steroid dose during illness and to carry injectable hydrocortisone for emergencies.^{[3, 4]} Even with treatment, people with Addison's disease have a higher death rate and reduced quality of life, partly because replacement cannot fully copy the body's natural daily cortisol rhythm.^[2]

Why Addison's Disease calls for a whole-person approach

Addison's disease is a hormone deficiency, and replacement tablets are the treatment. Many people still live with fatigue, stress, poor sleep and reduced quality of life, which are the areas where supportive care may be considered.^[2]

The factors below are the ones most relevant for daily living. None of them changes the need for medical treatment.

Illness, stress and adrenal crisis

Physical stress such as infection, surgery or injury can bring on an adrenal crisis when cortisol is not enough.^{[1, 3]} This is why every patient is taught how to raise steroid doses when ill. Any new illness or fever calls for medical advice before anything else.

Replacement that is not perfect

Current medicines cannot mimic the normal rhythm of cortisol release through the day, and this is one reason researchers think quality of life stays reduced.^[2]

Fatigue

Fatigue is the most commonly reported symptom in adrenal insufficiency.^[3] Ongoing fatigue should be raised with your endocrinologist, because dose adjustment or other conditions such as thyroid disease may be involved.^[4]

Related autoimmune conditions

Addison's disease can occur together with other autoimmune diseases, especially of the thyroid.^[4] Your physician monitors these, and we ask to know about them.

Acupuncture as supportive care in Addison's Disease

What the research shows

No clinical trials of acupuncture for Addison's disease were found in PubMed, so the evidence for treating the disease itself is absent. The only item we found was a small Chinese case report on a related adrenal problem, and its abstract was not available. What can be said concerns symptoms that people with many conditions share.

For fatigue, a meta-analysis of 16 trials with 1,346 people with chronic fatigue syndrome found a better response rate with acupuncture than with sham acupuncture, but most studies were of low quality and the authors reached no firm conclusion.^[5] For sleep, a meta-analysis of 24 trials found acupuncture improved insomnia scores compared with medication after about three weeks, with large differences between studies.^[6] These studies did not include people with Addison's disease, and fatigue from low cortisol has a different cause.

How acupuncture may work

Researchers have not studied how acupuncture might act in Addison's disease. We do not claim that acupuncture affects the adrenal glands or hormone levels, and it cannot substitute for cortisol replacement.

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes, over a short course of visits with reassessment. Sessions are aimed at comfort, relaxation, sleep and energy.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or a flare at a needle site, and serious events occurred in about 1 in 10,000 patients.^[7] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). Please also tell us if you are unwell, have a fever, vomiting or diarrhea, or have needed extra steroid doses, since treatment should wait until you have had medical advice.

Ayurvedic medicine as supportive care in Addison's Disease

The Ayurvedic view

Ayurveda has no condition that matches autoimmune adrenal failure. Practitioners may describe the weakness, tiredness and weight loss as depleted vitality or strength (ojas or bala) and as imbalance of the doshas. This is a traditional explanatory framework and not a biomedical diagnosis.

Therapies that may be used

Care is individual and chosen only after your medical treatment is established. It may include:

• Regular meals and daily routines, with enough salt and fluid as directed by your physician
• Gentle oil massage and relaxation practices
• Individually prescribed herbs, only after review of your medicines and endocrine history

Panchakarma is not appropriate during pregnancy, acute illness or frailty. Fasting, strong purgation and vomiting therapies are unsuitable in Addison's disease because dehydration and salt loss can trigger an adrenal crisis.

What the research shows

We found no studies of Ayurvedic treatment in Addison's disease, so evidence for the disease itself is none.

For general symptoms, a meta-analysis of 12 randomized trials found that ashwagandha lowered anxiety and stress scores compared with placebo, though certainty of the evidence was low and results varied widely.^[8] A meta-analysis of five trials found a small improvement in sleep, and the authors noted that long-term safety data are limited.^[9] These trials did not enrol people with Addison's disease. Any herb that may act on stress hormones or the immune system should be cleared with your endocrinologist first.

Herbal medicine as supportive care in Addison's Disease

Herbs and formulas that have been studied

We found no clinical trials of herbal medicine in Addison's disease. Herbs are discussed here mainly for safety, because several can change the effect of cortisol and aldosterone.

Licorice (Glycyrrhiza glabra, gan cao) is common in Chinese and Ayurvedic formulas and is the herb of greatest concern.^[10]

What the research shows

There is no evidence that herbs treat Addison's disease, so the evidence is none. Any supportive use is limited to general symptoms and is not supported by studies in this condition.

Safety and herb-drug interactions

Licorice can cause pseudoaldosteronism, with high blood pressure and low potassium.^{[10, 11]} The reason is that it blocks an enzyme, 11-beta-HSD2, that normally inactivates cortisol in tissues that respond to aldosterone, and so cortisol acts more strongly.^[12] Because people with Addison's disease take cortisol-like medicine, licorice could in theory strengthen its effect, and we avoid it unless your endocrinologist agrees.

Some herbal products have been reported to contain hidden steroids or to have glucocorticoid-like activity.^{[10, 13]} In one case report, a plant-extract skin cream had cortisol-like effects, and adrenal insufficiency followed when use stopped.^[13]

Herbs also interact with other medicines. Reviews describe bleeding when warfarin is combined with some herbs.^{[14, 15]} About one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[16] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding or have liver or kidney disease. Herbal preparations applied to the skin should also be disclosed to your physician.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine may describe fatigue, cold intolerance and low appetite as deficiency of kidney yang or spleen qi, and Ayurveda may describe depleted ojas. Modern medicine describes these symptoms in Addison's disease as the result of cortisol and aldosterone deficiency from adrenal destruction.^{[1, 2]}

No study has shown that qi, yang or ojas corresponds to adrenal function. The traditional terms may help a practitioner organize questions about energy, appetite and sleep, but they do not describe or treat the adrenal damage.

How this care fits with your medical care

Complementary care for Addison's disease is supportive only. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Take your hydrocortisone, fludrocortisone and any other prescribed medicines exactly as directed, and never stop or change them on the advice of anyone but your prescriber.

We do not diagnose or manage adrenal disease. Please bring your diagnosis, recent blood tests, a full list of medicines and supplements, your steroid emergency card and your sick-day plan.

When to seek urgent medical care

An adrenal crisis is a medical emergency, and early signs should not be waited out.^{[1, 3]}

• Severe weakness, dizziness or fainting, especially on standing
• Persistent vomiting or diarrhea, or being unable to keep down your steroid tablets
• Severe abdominal pain
• Confusion, drowsiness or a very low blood sugar
• Fever or other illness, injury or surgery when you are unsure how to adjust your steroid dose

If you have an emergency steroid injection, use it as your physician has taught you. Call 911 or go to the nearest emergency department.