Addison's Disease

Treatment Overview

Addison's disease develops when the adrenal glands, located above the kidneys, are not able to produce enough of the hormones cortisol and aldosterone. Treatment is usually lifelong. After proper treatment is started, most people with Addison's disease can lead healthy lives.

Treatment includes:

• Medicines to replace the hormones cortisol and aldosterone. Many doctors use a short-acting medicine called hydrocortisone, given 2 or 3 times a day. In some people, long-acting medicines such as prednisone, methylprednisolone, or dexamethasone can be used. You may also need a medicine that can function like aldosterone (usually fludrocortisone). Hydrocortisone is used because it can function like both of these hormones, although some people still need to take additional fludrocortisone. You will need a higher dose of medicine during childbirth; when you have an injury, surgery, or a serious infection; or during severe stress, such as the death of a loved one.
• Increasing salt in the diet. Because people with adrenal failure tend to lose sodium, you will need extra salt (sodium chloride) in your diet, especially during hot and humid weather and vigorous exercise. But because people with Addison's disease retain potassium, you need to avoid salt substitutes, which usually contain potassium chloride salts.
• Regular medical checkups to monitor symptoms and blood pressure. Your doctor also may need to do lab tests to evaluate and monitor blood levels of potassium and sodium.

During a stressful event, such as a severe infection, trauma, surgery, childbirth, dehydration, or an emotional event such as the death of a loved one, you could develop an adrenal crisis. Your body is not able to produce enough cortisol for the stressful condition. If an adrenal crisis is not treated, you may die from shock caused by a serious drop in blood pressure. You would need treatment in the hospital.

Recent small studies suggest that women with Addison's disease may benefit from taking a hormone replacement called dehydroepiandrosterone (DHEA). Some women who take this medicine every day may experience a greater sense of well-being and improvement in depression, anxiety, sexuality, and sensitivity to insulin.^{3, 4} If you are considering DHEA, talk to your doctor.

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Author:	Ralph Poore Caroline Rea, RN, BS, MS	Last Updated: April 9, 2008
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Alan C. Dalkin, MD - Endocrinology Andrew Swan, MD, CCFP, FCFP - Family Medicine
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