Adrenal Insufficiency (e.g. Addison Disease) Quiz
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Easily tired
Malaise
Low blood pressure
Hyperpigmentation
Dizziness
Brain fog
Dark skin
Weight loss
Muscle weakness
Skin discoloration
Extreme fatigue
Fainting
Not seeing your symptoms? No worries!
What is Adrenal Insufficiency (e.g. Addison Disease)?
The adrenal gland is an organ that releases hormones to control blood pressure and metabolism. In this condition, there are low hormone levels, and the causes include damage to the adrenal glands themselves or parts of the brain that control the adrenal gland. It can present with darkened areas of skin, extreme loss of body water, also known as dehydration, fatigue, weight loss that doesn't happen on purpose, nausea, vomiting or belly pain, lightheadedness or fainting, salt cravings, muscle or joint pains.
Typical Symptoms of Adrenal Insufficiency (e.g. Addison Disease)
- Dark spots on skin
- Feeling flustered or scared
- Difficulty concentrating
- Blood in stool
- Decreased motivation
- Dizziness when standing or after prolonged standing
- Fainting
- Recent weight loss
Diagnostic Questions for Adrenal Insufficiency (e.g. Addison Disease)
Your doctor may ask these questions to check for this disease:
- Do you have darkened skin?
- Do you feel overwhelmed or frightened every day?
- Do you have difficulty concentrating?
- Have you noticed any blood in your stool?
- Have you been experiencing decreased motivation recently?
Treatment of Adrenal Insufficiency (e.g. Addison Disease)
Treatment involves replacing the missing hormones. Regular follow-ups are necessary to ensure the hormone dose is correct. The doctor may also recommend a "sick day dose" to increase hormone levels when fighting an illness.
Reviewed By:
Unnati Patel, MD, MSc (Family Medicine)
Dr.Patel serves as Center Medical Director and a Primary Care Physician at Oak Street Health in Arizona. She graduated from the Zhejiang University School of Medicine prior to working in clinical research focused on preventive medicine at the University of Illinois and the University of Nevada. Dr. Patel earned her MSc in Global Health from Georgetown University, during which she worked with the WHO in Sierra Leone and Save the Children in Washington, D.C. She went on to complete her Family Medicine residency in Chicago at Norwegian American Hospital before completing a fellowship in Leadership in Value-based Care in conjunction with the Northwestern University Kellogg School of Management, where she earned her MBA. Dr. Patel’s interests include health tech and teaching medical students and she currently serves as Clinical Associate Professor at the University of Arizona School of Medicine.
Hidetaka Hamasaki, MD (Endocrinology)
Dr. Hamasaki graduated from the Hiroshima University School of Medicine and the Graduate School of Medicine, Jichi Medical University. He completed his residency at the Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Hospital and the Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine. He has served in the National Center for Global Health and Medicine Hospital and Kohnodai Hospital and joined Hamasaki Clinic in April 2017. Dr. Hamasaki specializes in diabetes and treats a wide range of internal medicine and endocrine disorders.
Content updated on Dec 6, 2024
Following the Medical Content Editorial Policy
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- Can't focus
- There is darkened skin on the toe
- Blood in stool
- Skin is blackened
- Lack of motivation
- Darker skin
- Easily distracted
- There is darkened skin on the chin
- There is darkened skin on the under the armpit
- Stools looks like strawberry jam
- Armpit skin is black
- I can not concentrate on my work
- Blackened skin
- Feeling less ambitious nowadays
- There is darkened skin on the toes of my foot
See full list
Symptoms Related to Adrenal Insufficiency (e.g. Addison Disease)
Diseases Related to Adrenal Insufficiency (e.g. Addison Disease)
FAQs
Q.
Always Exhausted? Why Your Adrenals Are Failing: Addison’s Disease Next Steps
A.
Persistent exhaustion with dizziness, weight loss, salt cravings, or skin darkening may signal Addison’s disease, a rare adrenal hormone deficiency that lowers cortisol and aldosterone, causing low blood pressure and risking a life-threatening adrenal crisis if untreated. Next steps include prompt medical evaluation with morning cortisol and ACTH stimulation testing, followed by steroid and fludrocortisone replacement if confirmed, stress dosing education, and an emergency plan; there are several factors to consider. See the complete details below for red flags, who is at risk, when to seek emergency care, and practical tips for living well.
References:
* Bornstein SR, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hammer GD, Husebye ES, Merke DP, Murad MH, Stratakis CA, Torpy DJ. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016 Feb;101(2):364-89. doi: 10.1210/jc.2015-1719. Epub 2015 Oct 20. PMID: 26509841.
* Rushworth RL, Torpy DJ, Stratakis CA. Management of primary adrenal insufficiency. J Clin Endocrinol Metab. 2021 May 18;106(6):1709-1721. doi: 10.1210/clinem/dgab183. PMID: 33730303.
* Husebye ES, Anderson M. Addison's Disease. Curr Treat Options Cardiovasc Med. 2020 Apr;22(4):5. doi: 10.1007/s11936-020-0774-7. PMID: 32367375.
* Allolio B. Adrenal crisis. Best Pract Res Clin Endocrinol Metab. 2015 Apr;29(2):299-307. doi: 10.1016/j.beem.2014.10.003. Epub 2014 Oct 22. PMID: 25987112.
* Chaudhry H, Tadi P. Addison Disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. PMID: 32491515.
Q.
Bone-Deep Fatigue? Why Your Adrenals Are Crashing: Addison’s Disease & Proven Next Steps
A.
Bone-deep fatigue that does not improve with rest can signal Addison’s disease, a rare but serious adrenal hormone deficiency causing low cortisol and aldosterone, with symptoms like weakness, dizziness, low blood pressure, salt cravings, skin darkening, and risk of life-threatening adrenal crisis. It is diagnosed with targeted tests such as morning cortisol, ACTH, electrolytes, and the ACTH stimulation test, and treated effectively with steroid replacement like hydrocortisone and fludrocortisone plus sick-day guidance; there are several factors to consider, including urgent red flags and step-by-step actions to take with your doctor, all detailed below.
References:
* pubmed.ncbi.nlm.nih.gov/33636294/
* pubmed.ncbi.nlm.nih.gov/26946218/
* pubmed.ncbi.nlm.nih.gov/28555239/
* pubmed.ncbi.nlm.nih.gov/34552554/
* pubmed.ncbi.nlm.nih.gov/37021191/
Q.
Addison’s Disease in Women 65+: 7 Signs You Shouldn't Ignore
A.
Key signs in women 65+ include persistent fatigue, unintended weight loss or poor appetite, low blood pressure with dizziness, progressive muscle weakness, ongoing digestive problems, mood or memory changes, and skin darkening or strong salt cravings. Because Addison’s is rare, treatable, and can become life-threatening during illness or stress if missed, there are several factors to consider. See below for urgent red flags, what to discuss with a doctor, how it is diagnosed, and a helpful symptom check tool to guide next steps.
References:
* den Hoed SAGF, van de Beek EF, de Man HFM, et al. Primary Adrenal Insufficiency in the Elderly: Clinical Features and Outcome. J Clin Endocrinol Metab. 2019 Jun 1;104(6):2110-2119. doi: 10.1210/jc.2018-02484. Epub 2019 May 14. PMID: 31086470.
* Arnaldi G, Bacchetti M, Zennaro R, et al. Addison's disease in older patients: clinical features and prognosis. Aging Clin Exp Res. 2018 Dec;30(12):1423-1428. doi: 10.1007/s40520-018-0951-6. Epub 2018 May 21. PMID: 29785661.
* Charmandari E, Kyriacou A, Beshyah SA, et al. Primary adrenal insufficiency in the elderly: a retrospective study of 52 cases. Eur J Endocrinol. 2012 Oct;167(4):465-72. doi: 10.1530/EJE-12-0082. Epub 2012 Jul 6. PMID: 22778330.
* Husebye ES, Allolio B, Arlt W, et al. Diagnosis and management of primary adrenal insufficiency: An update. Best Pract Res Clin Endocrinol Metab. 2021 Mar;35(2):101505. doi: 10.1016/j.beem.2021.101505. Epub 2021 Mar 11. PMID: 33712391.
* Dineen R, Thompson CJ, Sherlock M. Adrenal Insufficiency: Diagnosis and Management. Mayo Clin Proc. 2020 Feb;95(2):386-403. doi: 10.1016/j.mayocp.2019.08.012. Epub 2020 Jan 9. PMID: 31920677.
Q.
Does prednisolone weaken the immune system?
A.
Yes, prednisolone can weaken the immune system by affecting how it responds to infections and other foreign substances. See below to understand more.
References:
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Baris HE, Baris S, Karakoc-Aydiner E, Gokce I, Yildiz N, Cicekkoku D, et al. (2016). The effect of systemic corticosteroids on the innate and .... European journal of pediatrics, 26833050.
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Fedor ME, & Rubinstein A. (2006). Effects of long-term low-dose corticosteroid therapy on .... Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 16892792.
Q.
Can cortisol be the reason I’m gaining weight?
A.
Yes, cortisol, a hormone released during stress, can contribute to weight gain by affecting how your body stores fat.
References:
Hewagalamulage SD, Lee TK, Clarke IJ, & Henry BA. (2016). Stress, cortisol, and obesity: a role for .... Domestic animal endocrinology, 27345309.
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Moyer AE, Rodin J, Grilo CM, Cummings N, Larson LM, & Rebuffé-Scrive M. (1994). Stress-induced cortisol response and fat distribution in .... Obesity research, 16353426.
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Roberts CJ, Campbell IC, & Troop N. (2014). Increases in weight during chronic stress are partially .... European eating disorders review : the journal of the Eating Disorders Association, 24123563.
Q.
Can I safely make a ‘cortisol cocktail’ every morning instead of coffee?
A.
Drinks with adaptogens and caffeine may offer benefits, but it's important to understand their effects and consult a healthcare provider before replacing coffee with a 'cortisol cocktail.'
References:
Boolani A, Fuller DT, Mondal S, Wilkinson T, Darie CC, & Gumpricht E. (2020). Caffeine-Containing, Adaptogenic-Rich Drink Modulates .... Nutrients, 7399841.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7399841/
Baba Y, Inagaki S, Nakagawa S, Kobayashi M, Kaneko T, & Takihara T. (2021). Effects of Daily Matcha and Caffeine Intake on Mild Acute .... Nutrients, 8156288.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8156288/
Almudhi A, & Gabr SA. (2022). Green tea consumption and the management of adrenal .... Biomedical Reports, 8889529.
Q.
Can stress alone mess up my hormones?
A.
Yes, stress can affect your hormones, causing changes in your body and mood.
References:
MacLean CR, Walton KG, Wenneberg SR, Levitsky DK, Mandarino JP, Waziri R, et al. (1997). changes in hormone levels and responses to stress after 4 .... Psychoneuroendocrinology, 9226731.
https://pubmed.ncbi.nlm.nih.gov/9226731/
Wolkowitz OM, Epel ES, & Reus VI. (2001). Stress hormone-related psychopathology. The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry, 12587196.
https://pubmed.ncbi.nlm.nih.gov/12587196/
Charmandari E, Kino T, Souvatzoglou E, & Chrousos GP. (2003). Pediatric stress: hormonal mediators and human .... Hormone research, 12649570.
Q.
Do I actually have adrenal fatigue?
A.
Adrenal fatigue is not recognized as a real medical condition by experts. If you have symptoms like feeling very tired, it's important to talk to a doctor to find out the true cause.
References:
Ross IL, Jones J, & Blockman M. (2018). We are tired of 'adrenal fatigue'. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 30182895.
https://pubmed.ncbi.nlm.nih.gov/30182895/
Cadegiani FA, & Kater CE. (2016). Adrenal fatigue does not exist: a systematic review. BMC endocrine disorders, 27557747.
https://pubmed.ncbi.nlm.nih.gov/27557747/
Martin-Grace J, Dineen R, Sherlock M, & Thompson CJ. (2020). Adrenal insufficiency: Physiology, clinical presentation and .... Clinica chimica acta; international journal of clinical chemistry, 32035851.
Q.
Does coconut water really help with electrolytes?
A.
Coconut water can help with electrolytes and is a good choice for rehydration after exercise, similar to sports drinks.
References:
O'Brien BJ, Bell LR, Hennessy D, Denham J, & Paton CD. (2023). Coconut Water: A Sports Drink Alternative?. Sports (Basel, Switzerland), 37755860.
https://pubmed.ncbi.nlm.nih.gov/37755860/
Saat M, Singh R, Sirisinghe RG, & Nawawi M. (2002). Rehydration after exercise with fresh young coconut water .... Journal of physiological anthropology and applied human science, 12056182.
https://pubmed.ncbi.nlm.nih.gov/12056182/
Kalman DS, Feldman S, Krieger DR, & Bloomer RJ. (2012). Comparison of coconut water and a carbohydrate- .... Journal of the International Society of Sports Nutrition, 22257640.
Q.
How do I know if my cortisol is too high?
A.
High cortisol levels can be a sign of Cushing's syndrome, and tests like late-night salivary cortisol can help detect it. If you think your cortisol is high, talk to a doctor for proper testing.
References:
Ceccato F, & Boscaro M. (2016). Cushing's Syndrome: Screening and Diagnosis. High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension, 27160717.
https://pubmed.ncbi.nlm.nih.gov/27160717/
Raff H, Raff JL, & Findling JW. (1998). Late-night salivary cortisol as a screening test for Cushing's .... The Journal of clinical endocrinology and metabolism, 9709931.
https://pubmed.ncbi.nlm.nih.gov/9709931/
Balomenaki M, Margaritopoulos D, Vassiliadi DA, & Tsagarakis S. (2022). Diagnostic workup of Cushing's syndrome. Journal of neuroendocrinology, 35979805.
Q.
How much potassium or sodium is actually healthy?
A.
Healthy sodium and potassium levels can help you feel better and live longer. It's important to eat the right amount of both to stay healthy.
References:
Liu D, Tian Y, Wang R, Zhang T, Shen S, Zeng P, & Zou T. (2024). Sodium, potassium intake, and all-cause mortality. BMC public health, 38225648.
https://pubmed.ncbi.nlm.nih.gov/38225648/
Salman E, Kadota A, & Miura K. (2024). Global guidelines recommendations for dietary sodium and .... Hypertension research : official journal of the Japanese Society of Hypertension, 38589606.
https://pubmed.ncbi.nlm.nih.gov/38589606/
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee to Review the Dietary Reference Intakes for Sodium and Potassium, Oria M, Harrison M, & Stallings VA. (2019). Dietary Reference Intakes for Sodium and Potassium. Unknown Journal, 30844154.
Q.
Is it bad that I feel tired all the time, even if my labs are normal?
A.
Feeling tired all the time, even with normal labs, can still be a concern. It might be related to conditions like chronic fatigue syndrome, which aren't always detected by standard tests.
References:
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https://pubmed.ncbi.nlm.nih.gov/7738491/
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Lane TJ, Matthews DA, & Manu P. (1990). The low yield of physical examinations and laboratory .... The American journal of the medical sciences, 2337122.
Q.
Is it safe to self-treat fatigue with electrolytes and juice?
A.
Drinking electrolytes and juice can help with mild fatigue, but it's important to ensure you're not missing other health issues.
References:
Popkin BM, D’Anci KE, & Rosenberg IH. (2010). Water, Hydration and Health - PMC. Nutrition reviews, 2908954.
https://pmc.ncbi.nlm.nih.gov/articles/PMC2908954/
Rebelo-Marques A, Coelho-Ribeiro B, De Sousa Lages A, Andrade R, Afonso J, Pereira R, et al. (2024). Trends and Missing Links in (De)Hydration Research. Nutrients, 11174495.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11174495/
Wang B, Wei X, Zhao X, Wang W, Deng J, & Yang H. (2024). A Review on In Vivo Research Dehydration Models and .... Nutrients, 11510460.
Q.
Is there a way to test for ‘adrenal fatigue’ even if it’s not real?
A.
There is no scientific test for 'adrenal fatigue,' but stress and fatigue can be measured in other ways.
References:
Hosoyama T, Tachi C, Yamanouchi K, & Nishihara M. (2005). Long term adrenal insufficiency induces skeletal muscle .... Zoological science, 15738643.
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Azzinnari D, Sigrist H, Staehli S, Palme R, Hildebrandt T, Leparc G, et al. (2014). Mouse social stress induces increased fear conditioning, .... Neuropharmacology, 24907589.
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Chilcot J, Norton S, Kelly ME, & Moss-Morris R. (2016). The Chalder Fatigue Questionnaire is a valid and reliable .... Multiple sclerosis (Houndmills, Basingstoke, England), 26232100.
Q.
Is there any science behind adrenal cocktails?
A.
Adrenal cocktails are supplements that claim to support adrenal health, but their effectiveness is not well-supported by scientific evidence. Some ingredients may have effects on fatigue, but more research is needed.
References:
Akturk HK, Chindris AM, Hines JM, Singh RJ, & Bernet VJ. (2018). Over-the-Counter "Adrenal Support" Supplements Contain .... Mayo Clinic proceedings, 29502560.
https://pubmed.ncbi.nlm.nih.gov/29502560/
Panossian A, & Wikman G. (2009). Evidence-based efficacy of adaptogens in fatigue, and .... Current clinical pharmacology, 19500070.
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Jaroenporn S, Yamamoto T, Itabashi A, Nakamura K, Azumano I, Watanabe G, & Taya K. (2008). Effects of pantothenic acid supplementation on adrenal .... Biological & pharmaceutical bulletin, 18520055.
Q.
What are real signs of adrenal insufficiency?
A.
Adrenal insufficiency can cause tiredness, muscle weakness, weight loss, low blood pressure, and darkening of the skin.
References:
Martin-Grace J, Dineen R, Sherlock M, & Thompson CJ. (2020). Adrenal insufficiency: Physiology, clinical presentation and .... Clinica chimica acta; international journal of clinical chemistry, 32035851.
https://pubmed.ncbi.nlm.nih.gov/32035851/
Husebye ES, Pearce SH, Krone NP, & Kämpe O. (2021). Adrenal insufficiency. Lancet (London, England), 33484633.
https://pubmed.ncbi.nlm.nih.gov/33484633/
Hahner S, Ross RJ, Arlt W, Bancos I, Burger-Stritt S, Torpy DJ, et al. (2021). Adrenal insufficiency. Nature reviews. Disease primers, 33707469.
Q.
What does cortisol actually do in the body?
A.
Cortisol is a hormone that helps the body respond to stress, keep energy levels steady, and control inflammation.
References:
Knezevic E, Nenic K, Milanovic V, & Knezevic NN. (2023). The Role of Cortisol in Chronic Stress, Neurodegenerative .... Cells, 38067154.
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Lightman SL, Birnie MT, & Conway-Campbell BL. (2020). Dynamics of ACTH and Cortisol Secretion and Implications .... Endocrine reviews, 32060528.
Q.
What’s the best time of day to drink a cortisol cocktail?
A.
The best time to consume a cortisol cocktail may depend on how your body reacts to caffeine, as it can increase cortisol levels. However, for specific timing recommendations, it is best to consult a healthcare provider.
References:
Lovallo WR, Whitsett TL, al'Absi M, Sung BH, Vincent AS, & Wilson MF. (2005). Caffeine Stimulation of Cortisol Secretion Across the .... Psychosomatic medicine, 2257922.
https://pmc.ncbi.nlm.nih.gov/articles/PMC2257922/
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Woods NF, Mitchell ES, & Smith-DiJulio K. (2009). Cortisol Levels during the Menopausal Transition and .... Menopause (New York, N.Y.), 2749064.
Q.
Will people judge me if I believe in adrenal fatigue?
A.
People may have different views about adrenal fatigue, and it's important to understand how your beliefs can affect your emotions and well-being.
References:
Lu Y, Jin X, Feng LW, Tang C, Neo M, & Ho RC. (2022). Effects of illness perception on negative emotions and .... World Journal of Clinical Cases, 9791537.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9791537/
Khammissa RA, Nemutandani S, Feller G, Lemmer J, & Feller L. (2022). Burnout phenomenon: neurophysiological factors, clinical .... The Journal of International Medical Research, 9478693.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9478693/
Slagboom TN, Deijen JB, Van Bunderen CC, Knoop HA, & Drent ML. (2021). Psychological well-being and illness perceptions in .... Pituitary, 8270855.
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Addison's Disease - Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/addisons-disease/symptoms-causes/syc-20350293#:~:text=Overview,little%20of%20another%20hormone%2C%20aldosterone.Munir S, Quintanilla Rodriguez BS, Waseem M. Addison Disease. 2023 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 28723023.
https://pubmed.ncbi.nlm.nih.gov/28723023/#:~:text=Addison%20disease%20is%20an%20acquired,potentially%20life%2Dthreatening%20emergency%20condition.