How is Addison’s disease treated?

The treatment for Addison’s disease will involve substituting or replacing the hormones that are normally produced by your adrenal glands in order to address the deficiency.

Treating cortisol deficiency

Cortisol will typically be replaced orally through hydrocortisone tablets which are a synthetic form of glucocorticoid. This will be taken once or in some cases, twice daily.

If there is a deficiency of aldosterone, this hormone will be replaced through oral doses of a tablet form of mineralocorticoid named fludrocortisone acetate (Florinef), this will also be taken twice daily.

Treating aldosterone deficiency

If you are receiving treatment for the replacement of aldosterone, then you may be advised by your doctor to increase your intake of salt (sodium) as your body’s ability to reabsorb sodium will be affected as aldosterone stimulates the use of salt in the body. Should you have secondary adrenal insufficiency, then you will typically be able to maintain your production of aldosterone naturally and will not require replacement therapy.

The doses of the different kinds of medications will be adjusted according to your individual needs.

Treating acute adrenal crisis

During an acute adrenal crisis or Addisonian crisis, you may experience symptoms such as:

• Low blood pressure (hypotension)
• High potassium levels (hyperkalaemia)
• Low blood sugar (hypoglycaemia)

These symptoms, if left untreated, can be fatal and the standard form of treatment will be immediate (within the first hour of symptoms manifesting) and involve intravenous injections consisting of salt water (saline), hydrocortisone, as well as sugar (dextrose).

This form of treatment will typically result in the rapid improvement of symptoms. It is also possible to take these medications and fluids by mouth, and hydrocortisone will be slowly decreased until the medication reaches a maintenance dose.

If there is a deficiency of aldosterone, then the maintenance therapy will also include fludrocortisone acetate taken in oral doses.

**My Med Memo – Hydrocortisone is a form of steroid that reduces the body’s natural inflammatory reaction which results in inflammation, swelling and redness. Fludrocortisone is also a form of steroid and is used to prevent the release of certain substances in the body that result in inflammation and to control the amounts of fluids and sodium in the body. Fludrocortisone is also used to treat low levels of glucocorticoids which are needed in order for the body to function. It works by stimulating the kidneys to retain the sodium present in the body and also acts as a replacement for cortisol.

Both hydrocortisone and fludrocortisone are corticosteroids which mimic the effects of natural hormones found in the body produced by your adrenal glands. When corticosteroids are administered in doses that exceed the body’s natural levels, they are able to suppress inflammation.

Monitoring adrenal insufficiency during stress

If you suffer from adrenal insufficiency, it is vital that you are monitored and pay attention to situations that cause an increase in your stress levels, particularly if you are pregnant, undergoing surgery or are suffering from an injury or illness.

Partaking in sports that are strenuous can also play a role in your stress levels, as can working late shifts at work. Stress affects your cortisol levels, because of this, if you are often in these sorts of situations then you may require additional treatment in order for the ‘stress’ dosages of cortisol and other corticosteroids to be recovered. This treatment can be administered orally or intravenously.

Surgery and adrenal insufficiency

If you suffer from chronic adrenal insufficiency, meaning you suffer from both a cortisol and aldosterone deficiency, and undergo general anaesthesia you will need to be treated intravenously with saline and hydrocortisone. These injections will begin the evening before your surgery and will continue until you are awake and able to take these orally. The dosage will be adjusted until the maintenance level is reached before your surgery.

Pregnancy and adrenal insufficiency

If you are pregnant and have primary adrenal insufficiency (when the adrenal glands are so severely damaged they are no longer able to produce the vital hormones needed for bodily functions), you will be treated with the standard method of hormone replacement therapy. If you experience nausea followed by vomiting in the early stages of your pregnancy, this may interfere with the oral hormone medication and therefore injections may be required.

During the delivery of your baby, the treatment will be similar to that of those undergoing surgery. After the delivery, the dosage will be gradually decreased and the maintenance dosage of fludrocortisone and hydrocortisone will be reached through taking the medications orally at about ten days after the birth of your child.

**My Med Memo – A maintenance dose is a dosage of hormones that will replace the deficient hormones at the same rate that they are lost or not produced by the adrenal glands (dosage is equal to the rate of elimination). A maintenance dose is normally a fixed and small dose and it may take time to reach this point.

Diet, nutrition and adrenal insufficiency

If you have Addison’s disease and also suffer from decreased levels of aldosterone, then it may be beneficial to maintain a diet that contains a high amount of sodium (salt). Your doctor or dietician may be able to help you with guidelines and specific suggestions as to how much sodium is required.

Some foods that are naturally high in sodium include:

• Beetroot
• Celery
• Carrots
• Meat (chicken, beef, lamb, pork, etc.)
• Chard
• Spinach

The side effect of treatment with steroids is often osteoporosis, this is a disorder wherein your bones lose some of their density and can break easily. This condition can be prevented through the use of calcium supplements and consumption of calcium-rich foods, as well as the inclusion of vitamin D, this will aid in maintaining sound bone health.

Adjusting medication when you have Addison's disease

You may be required to adjust your medication in certain situations, it is best that you speak to your doctor or endocrinologist before doing so, however, he or she is likely to have already prepared you on how to do this.

If you experience any of the below then you may have to adjust your medication:

• You are in a car crash or an accident of some kind
• You have to have surgery performed or a medical procedure of some kind such as an endoscopy or a dental filling
• You are partaking in strenuous physical exercise that is not normally a part of your exercise regime
• You have an infection or illness where you develop a fever

Adjusting your medication will aid in assisting your body to cope with any of the additional stress caused by various scenarios. Your endocrinologist will advise you on how to adjust your medication specifically. After taking medication over a longer period of time, you will eventually adjust to it and be able to identify what triggers any symptoms of Addison’s disease.

Bear in mind that the treatment for Addison’s disease is lifelong and ongoing medical consultation is necessary as various situations arise.