Treatment - Addison's disease

If you have Addison’s disease, you'll need to take daily medication to replace the lost hormones. This should help you to live an active life. Many people find they still need to manage their fatigue.

In some cases, the underlying causes of Addison’s disease can be treated. For example, tuberculosis (TB) is treated with a course of antibiotics over a period of at least 6 months.

But most cases are caused by a problem with the immune system that can't be cured.

Medication for Addison’s disease

Treatment usually involves corticosteroid (steroid) replacement therapy for life. Corticosteroid medication is used to replace the hormones cortisol and aldosterone. With Addison's disease your body no longer produces these. It's usually taken in tablet form 2 or 3 times a day.

In most cases, a medication called hydrocortisone is used to replace the cortisol. Other possible medicines are prednisolone or dexamethasone, though these are less commonly used.

Aldosterone can be replaced with a medication called fludrocortisone. Your GP may also ask you to add extra salt to your daily diet. But if you're taking enough fludrocortisone medicine this may not be necessary. Unlike most people, if you feel the urge to eat something salty, then you should eat it.

Addison's disease medications don't usually have side effects. If you take a higher dose than necessary for a long time, there's a risk of problems. For example, weakened bones (osteoporosis), mood swings and difficulty sleeping (insomnia).

Living with Addison’s disease

Many people with Addison’s disease keep a normal diet and exercise routines if they take medication. But bouts of fatigue are common. It can take some time to learn how to manage these periods of low energy.

Some people find that needing to take regular doses of medication is restrictive. It can affect daily life or emotional health. Missing a dose of medication, or taking it late, can also lead to exhaustion or insomnia.

Some people can develop associated health conditions which need extra treatment and management, for example, diabetes or an underactive thyroid.

You'll usually need to have appointments with an endocrinologist every 6 to 12 months. This is so they can review your progress and adjust your medication dose, if necessary. Your GP can provide support and repeat prescriptions between these visits.

Failing to take your medication could lead to a serious condition called an adrenal crisis.

To avoid this you must:

• remember to collect your repeat prescriptions
• keep spare medication as necessary. For example, in the car or at work, and always carry some spare medication with you
• take your medication every day at the right time
• pack extra medication if you are going away. This is usually double what you would normally need, plus your injection kit
• carry your medication in your hand luggage if you are travelling by plane. Carry a note from your doctor explaining why it is necessary.

You could also inform close friends or colleagues of your condition. Tell them about the signs of adrenal crisis and what they should do if you experience one.

If you see a different GP or a dentist from your usual one, make sure they know you have Addison's disease and that you take steroid replacement medication.

Medical alert bracelets

It's a good idea to wear a medical alert bracelet or necklace that informs people you have Addison’s disease.

After a serious accident, such as a car crash, a healthy person produces more cortisol. This helps you cope with the stressful situation and extra strain on your body that results from serious injury. As your body cannot produce cortisol, you'll need a hydrocortisone injection to replace it and prevent an adrenal crisis.

Wearing a medical alert bracelet will inform any medical staff treating you about your condition. It will tell them what medication you need.

If you need to stay in hospital, the healthcare professionals caring for you will also need to know you need steroid replacement medication. It's important to note that this advice still applies if you're not supposed to eat or drink (nil by mouth) for any reason. Steroid replacement medication can be given by injection if you cannot eat or drink.

Adjusting your medication

At certain times, your medication may need to be adjusted. This is to take into account extra strain on your body.

For example, you may need to increase the dosage of your medication if you experience:

• an illness or infection – particularly if you have a high temperature of 38 degrees Celsius or above
• an accident, such as a car crash
• an operation, dental or medical procedure (such as a tooth filling or endoscopy)
• you're taking part in strenuous exercise not usually part of your daily life

This will help your body cope with the extra stress. Your endocrinologist will monitor your dosage and tell you about any changes. Over time, as you get used to the condition and learn what can trigger your symptoms, you may learn how to adjust your medication yourself. Always consult your GP if you're unsure.

Emergency treatment

You and a partner or family member may be trained to administer an injection of hydrocortisone in an emergency.

This could be necessary if you go into shock after an injury. Or you might need it if you experience vomiting or diarrhoea and are unable to keep down oral medication. This may occur if you're pregnant and have morning sickness. Your endocrinologist will discuss with you when an injection might be necessary.

If you need to administer emergency hydrocortisone, always call your GP immediately afterwards. Check what out-of-hours services are available in your local area, in case the emergency is outside normal working hours.

Treating adrenal crisis

Adrenal crisis, or Addisonian crisis, needs urgent medical attention. Dial 999 for an ambulance if you or someone you know are experiencing adrenal crisis.

Signs of an adrenal crisis include:

• severe dehydration
• pale, cold, clammy skin
• sweating
• rapid, shallow breathing
• dizziness
• severe vomiting and diarrhoea
• severe muscle weakness
• headache
• severe drowsiness or loss of consciousness

In hospital, you'll be given lots of fluid through a vein in your arm to rehydrate you. This will contain a mixture of salts and sugars (sodium, glucose and dextrose). This is to replace salts and sugars your body is lacking. You'll also be injected with hydrocortisone to replace the missing cortisol hormone.

Any underlying causes of the adrenal crisis, such as an infection, will also be treated.