Addison’s disease, also known as primary adrenal insufficiency, is a serious, chronic disorder requiring specialized, lifelong medical management. The condition arises when the small adrenal glands, located atop the kidneys, fail to produce sufficient amounts of the steroid hormones cortisol and aldosterone. Cortisol regulates metabolism and blood pressure, while aldosterone manages the balance of sodium and potassium.
The Initial Contact: Primary Care Physicians
The journey toward a diagnosis often begins with a Primary Care Physician (PCP) or General Practitioner (GP) because the initial symptoms are frequently vague and non-specific. Patients commonly report persistent fatigue, unexplained weight loss, and low blood pressure causing dizziness upon standing. Other subtle signs, such as nausea, abdominal pain, and an unusual craving for salt, may also be present, mimicking less serious conditions.
A PCP must recognize this constellation of symptoms and maintain a high index of suspicion for a hormonal disorder. Initial screening involves basic blood work to check for electrolyte imbalances, specifically low sodium (hyponatremia) and high potassium (hyperkalemia), which suggest aldosterone deficiency. The physician may also order an early morning serum cortisol level, along with an adrenocorticotropic hormone (ACTH) test, to assess the adrenal gland’s function. If these initial results or the clinical presentation suggest adrenal insufficiency, the PCP initiates an urgent referral to a specialist for definitive testing and long-term care.
Specialized Treatment: The Role of the Endocrinologist
The endocrinologist, a physician specializing in hormones and the endocrine system, is the definitive expert for diagnosing and managing Addison’s disease. Upon referral, the endocrinologist confirms the diagnosis using the ACTH stimulation test, which measures the adrenal glands’ cortisol response after administering synthetic ACTH. A blunted cortisol increase confirms primary adrenal insufficiency. The specialist also determines the underlying cause, which in the majority of cases is an autoimmune process identified through a blood test for 21-hydroxylase antibodies.
Long-term management involves precise hormone replacement therapy tailored to the individual patient. This requires replacing the missing cortisol with a synthetic glucocorticoid, such as hydrocortisone, often taken in divided daily doses to mimic the body’s natural circadian rhythm. The missing aldosterone is replaced with the mineralocorticoid fludrocortisone, with dosage carefully adjusted based on blood pressure readings and laboratory measures.
The goal is to find the lowest effective dose to control symptoms and prevent risks associated with over-treatment, such as osteoporosis or hypertension. Regular follow-up appointments with the endocrinologist are necessary to continually adjust these replacement doses as the patient’s life circumstances or health status change.
Navigating Emergency Care and Ongoing Coordination
The most dangerous complication is an Adrenal Crisis, a life-threatening medical emergency triggered by physical stress like infection, trauma, or surgery. Symptoms include sudden, severe pain in the legs, abdomen, or lower back, extreme weakness, vomiting, and confusion, leading rapidly to shock. Should these symptoms appear, immediate emergency medical intervention is required, often administered by Emergency Room physicians and intensive care staff.
The emergency protocol demands immediate treatment, which includes an intravenous (IV) bolus of 100 milligrams of hydrocortisone, followed by a continuous infusion, alongside rapid fluid resuscitation with IV isotonic saline. This intervention cannot be delayed for diagnostic testing. Effective long-term safety depends on seamless coordination between the endocrinologist, the PCP, and the patient. The endocrinologist provides a detailed sick-day protocol for stress dosing—temporarily increasing the hydrocortisone dose during minor illnesses—and insists the patient carry a steroid emergency card at all times. This card ensures that any healthcare professional, including emergency staff, is immediately aware of the patient’s condition and the need for prompt steroid administration.