Cortisol - Addison Disease

What is Addison disease?

A condition characterized by insufficient production of cortisol, aldosterone, and adrenal androgens due to adrenal cortex dysfunction.

What is the main pathophysiology of Addison disease?

Deficiency of ACTH → primary adrenal insufficiency; the adrenal cortex cannot meet hormonal needs.

What stimulates the adrenal cortex to produce cortisol and aldosterone?

Adrenocorticotropic hormone (ACTH).

What happens when ACTH is lacking?

Cortisol deficiency occurs.

What accounts for ~90% of Addison disease cases?

Autoimmune adrenalitis.

What are the three major groups of hormones produced by the adrenal cortex?

• Glucocorticoids

• Mineralocorticoids

• Androgens

What is the function of glucocorticoids such as cortisol?

Regulate metabolism and stress response.

What is the function of mineralocorticoids such as aldosterone?

• Control sodium

• Water balance

What is the role of adrenal androgens?

Sex hormones with minor systemic effects.

What is the most common primary cause of Addison disease?

Autoimmune destruction of the adrenal cortex.

What infections can cause primary Addison disease?

• Tuberculosis (TB)

• HIV

• Fungal infections

What drug-related cause can lead to Addison disease?

Abrupt withdrawal of long-term corticosteroid therapy (never stop suddenly).

What types of physical adrenal loss can cause Addison disease?

Bilateral adrenalectomy, adrenal hemorrhage, or infarction.

What is an other primary cause of Addison disease? 

Idiopathic causes

What causes secondary adrenal insufficiency?

Pituitary dysfunction → decreased ACTH → reduced adrenal stimulation.

How can cancer contribute to Addison disease?

Oncologic involvement with metastasis to adrenal glands.

What surgical or vascular event can cause secondary insufficiency?

Removal of adrenal glands or adrenal hemorrhage/infarction.

What is a major risk if Addison disease is untreated?

Patients may die from lack of ACTH stimulation.

List the signs & symptoms of

• Fatigue and muscle weakness

• Hyperpigmentation

• Hypotension (orthostatic), tachycardia (shock)

• Electrolyte disturbances: hyponatremia, hyperkalemia

• Hypoglycemia

• Salt craving

• Weight loss, anorexia, nausea, vomiting

What causes fatigue and muscle weakness in Addison disease?

Low cortisol levels.

What causes hyperpigmentation in Addison’s disease?

Increased ACTH → increased melanin (bronze knuckles, elbows, knees, scars).

What cardiovascular signs appear in Addison disease?

Hypotension (often orthostatic) and tachycardia.

What electrolyte disturbances occur in Addison’s disease?

Hyponatremia -

Hyperkalemia - 

What metabolic issue is common in Addison disease?

Hypoglycemia.

What gastrointestinal symptoms may occur in Addison’s disease?

Weight loss, anorexia, nausea, vomiting.

What craving is associated with Addison’s disease?

Salt craving.

What happens to serum sodium in Addison’s disease?

Serum sodium decreases.

What happens to serum potassium in Addison’s disease?

Serum potassium increases.

What happens to blood glucose in Addison’s disease?

Blood glucose decreases

What happens to serum cortisol in Addison’s disease?

Serum cortisol decreases.

What happens to ACTH levels in primary Addison disease?

ACTH increases.

What happens to renin activity in Addison disease?

Renin activity increases.

What imaging is used to assess adrenal structure in Addison disease?

CT or MRI of adrenal glands.

What is Addisonian crisis?

• Acute life-threatening decompensation triggered by stress

• Infection

• Trauma

• Sudden drug withdrawal

What are signs of Addisonian crisis?

• Severe hypotension

• Tachycardia

• Dehydration

• Profound hyponatremia

• Hypoglycemia

What IV fluids are used for Addisonian crisis?

0.9% normal saline; add dextrose (e.g., D5NS) for hypoglycemia.

What is the emergency glucocorticoid treatment for Addisonian crisis?

IV hydrocortisone 100 mg bolus, then 200 mg/24 h infusion or 50 mg every 6 h.

What monitoring is required during Addisonian crisis?

• Blood pressure

• Cardiac rhythm

• Urine output

• Serial electrolytes and glucose

What psychological assessment should be included in crisis management?

Screen for suicidal ideation.

What is the long-term treatment for Addison disease?

Lifelong glucocorticoid replacement.

What medication is used for long-term mineralocorticoid replacement?

Fludrocortisone.

Why should steroids never be stopped abruptly?

Risk of adrenal crisis.

What is stress-dosing in Addison disease?

Increasing steroid dose during illness or surgery.

What side effects should patients be counseled about with chronic steroid therapy?

• Hypertension

• Bone demineralization

• Increased infection risk

What should patients wear for safety?

A medical alert bracelet.