Patient information from BMJ

Primary adrenal insufficiency (Addison's disease): what are the treatment options?

Last published:May 03, 2022

Primary adrenal insufficiency (Addison’s disease) is a rare condition that affects the body’s ability to produce certain hormones. It causes extreme tiredness and weakness and can be life threatening if not treated. But drug treatments can help most people live a normal life.

What treatments are available?

Primary adrenal insufficiency (PAI) affects two small glands that sit just above the kidneys called the adrenal glands. These glands produce hormones, including two called cortisol and aldosterone.

PAI used to be called Addison's disease. And this is still the name by which most people know the condition.

If you have PAI these glands are damaged and can’t produce enough of these hormones. This causes symptoms including extreme tiredness. If left untreated the condition can be life threatening.

If your levels of cortisol drop to life-threatening levels, this is called an adrenal crisis. During an adrenal crisis the symptoms of PAI you have severe symptoms of PAI. This is a medical emergency and you need to get medical help straight away.

For more background information, and for information on symptoms, see our leaflet: Primary adrenal insufficiency (Addison’s disease): what is it?

The treatment for PAI is to replace the hormones that the adrenal glands don’t make enough of.

This is done with medicines called corticosteroids, which mimic the actions of the hormones made by the adrenal glands. You will need to take them for the rest of your life. You will probably also need to take a medicine to help with your salt and water balance.

It probably won’t be clear straight away how much of the medicines you need to take, as it varies from person to person. So your doctor or a specialist nurse will explain to you how the medicine works and how to increase the dose if your symptoms don’t go away.

There might also be times in your life when you need to increase how much medicine you take, such as if:

• you have had an infection

• you have been doing a lot of exercise, or

• you need surgery.

Women might also need to take more of their medicine while pregnant.

If you have any doubts or questions about your medicine dose, talk with your doctor.

If you are diagnosed with PAI during an adrenal crisis you will be given the corticosteroids by injection until you are stable and can switch to taking tablets.

What to expect in the future

If you have PAI you will need to take your medicine for the rest of your life. Your doctor will discuss with you how to take your medicine, and about times when you may need to take more than usual.

Not taking your medicine means that your symptoms will return, and that you could have an adrenal crisis. So it’s important to always make sure that your supply of medicines doesn’t run too low.

Once your condition is stable you will need to see your doctor and perhaps a specialist every year to discuss your condition and how your medicine is working.

There are various things you can do to stay healthy. For example, everyone with PAI should carry a medical alert card or wear a medical alert bracelet. If you are in an accident or lose consciousness for any reason, your doctor will then know that you need your corticosteroid medicine.

You should also keep emergency injections at home in case you lose consciousness or are in an accident. Family members should be taught how to give you these injections in case you can’t, because of an adrenal crisis or for any other reason.

It’s important to keep an eye on when your emergency injections are due to reach their expiry date, so that you get replacements in plenty of time.

You can find training on how to give the injections online. For example, in the UK the Addison's Disease Self Help Group (addisonsdisease.org.uk) gives advice on this as well as help and support about all aspects of Addison’s disease.