Possible adrenal crisis? Use your prescribed emergency plan and seek emergency medical care. Adrenal crisis

01 Primary AI

Addison’s disease / primary adrenal insufficiency

When the adrenal glands themselves cannot produce enough essential hormones.

What this type is

Addison’s disease is a name many people use for primary adrenal insufficiency. In this form, the adrenal glands themselves cannot produce enough of the hormones they normally make. Cortisol (a glucocorticoid) is one of those hormones. The body needs cortisol to respond to illness, injury, infection, surgery, dehydration, severe stress, or other physical demands.

The adrenal glands sit above the kidneys. In primary AI, the glands are the starting point of the problem—not the pituitary’s ACTH signal, and not hypothalamic CRH or suppression from glucocorticoid medicines.

How this type is typically acquired

Primary adrenal insufficiency happens when the adrenal glands fail, are damaged, are removed, or never develop as expected. Causes fall into several groups:

Autoimmune adrenalitis. In many regions, an autoimmune process that targets the adrenal cortex is a common cause. The immune system injures the tissue that makes adrenal hormones. Your team may also look for related autoimmune conditions.
Infection. Infections can involve or destroy adrenal tissue. In some settings, tuberculosis has been discussed historically as a cause of adrenal failure. Other infections may be considered depending on your history and where you live or have traveled.
Hemorrhage or infarction. Bleeding into an adrenal gland, or loss of blood supply, can damage the gland. This may be discussed after certain illnesses, clotting problems, trauma, or other events your clinician identifies.
Surgery / adrenalectomy. One or both adrenal glands may be removed for tumors or other surgical indications. When both glands are gone, the body cannot make adrenal hormones from those glands.
Infiltrative or metastatic disease. Other diseases can grow into or replace adrenal tissue, including cancers that spread to the adrenals and infiltrative disorders your clinician may name.
Genetic or developmental adrenal disorders. Some people are born with, or later diagnosed with, genetic or developmental conditions that affect how the adrenal glands form or work.
Other causes your clinician identifies. Additional pathways exist. If your history does not match a common category, your clinician can still identify the cause.

Congenital adrenal hyperplasia (CAH) involves the adrenal glands and hormone pathways, but it is a distinct condition. Clinicians distinguish CAH from Addison’s disease / primary adrenal insufficiency rather than treating the names as interchangeable.

Science: the HPA axis when the glands are the problem

The hypothalamus–pituitary–adrenal (HPA) axis is a communication loop:

The hypothalamus releases corticotropin-releasing hormone (CRH).
CRH tells the pituitary to release adrenocorticotropic hormone (ACTH).
ACTH tells the adrenal glands to make cortisol.

When the adrenal glands cannot respond, cortisol can stay low even if the brain and pituitary send a strong ACTH signal. ACTH is often high in primary AI because the feedback “off switch” (adequate cortisol) is missing. Your clinician interprets your lab pattern.

The adrenal cortex also makes mineralocorticoids such as aldosterone, which help the body handle salt and circulating volume. In primary AI, that pathway can be affected along with cortisol because the gland itself is involved. That is one reason teams may talk about salt, fluids, and a mineralocorticoid medicine when they prescribe it—unlike many secondary and tertiary situations, where aldosterone is more often relatively preserved because it is driven more by other systems (including renin–angiotensin) than by ACTH.

People with any type of adrenal insufficiency can still face adrenal crisis when cortisol demand outstrips what the body can supply. Crisis education lives on the adrenal crisis page.

Testing your team may discuss

Your team may discuss tests such as:

A morning cortisol blood test
An ACTH (adrenocorticotropic hormone) level, often discussed together with cortisol to help locate the problem in the glands versus the pituitary
Cosyntropin (ACTH stimulation) testing
Renin and aldosterone testing when the clinician wants to understand mineralocorticoid status
Electrolytes and other routine labs the team orders
Antibody testing related to autoimmune adrenal disease, when that is relevant
Imaging of the adrenal glands (for example CT or MRI) when the clinician orders it
Tests that help distinguish primary AI from CAH or other gland conditions, when the history points that way

Your clinician decides which tests to use, in what order, and what the results mean.

Questions to ask your medical team

Bring these to your visit:

Do I have primary adrenal insufficiency / Addison’s disease, and what in my history and testing supports that type?
Is mineralocorticoid (aldosterone-related) replacement part of my plan, and how will we watch salt, fluids, and blood pressure?
What is my everyday glucocorticoid plan, and what is my sick-day or stress-dosing plan when I have fever, vomiting, injury, or a procedure?
Will you train me (and a caregiver) on an emergency glucocorticoid injection, and what belongs in my kit?
What should I tell emergency responders and the ER, and do I have a letter or protocol to carry?
Should I wear medical identification, and what wording do you recommend?
Which other medicines, supplements, or conditions should you know about because they affect adrenal care?
How often should I follow up, and which specialists (endocrinology and others) are on my team?
If I have autoimmune disease elsewhere, or a family history, what else should we screen for?