Addison's disease (adrenal insufficiency)

For a lay person:

Addison's disease is a rare condition in which the adrenal glands stop making enough of the hormones cortisol and aldosterone. It develops gradually, causing tiredness, weight loss, low blood pressure and darkened skin, and it can suddenly become life-threatening during illness or stress.

For a trained medical person:

Primary adrenal insufficiency, most often autoimmune in developed countries and tuberculous elsewhere, causing glucocorticoid and mineralocorticoid deficiency with raised ACTH and hyperpigmentation. Diagnosis rests on a low morning cortisol with an inadequate response to a short Synacthen (ACTH stimulation) test, plus renin, ACTH and adrenal autoantibodies. Treatment is lifelong glucocorticoid and mineralocorticoid replacement, with sick-day rules, emergency injectable hydrocortisone and patient education.

In Chinese medicine:

Liu and Tseng's textbook differentiates this condition into these patterns: Kidney Deficiency and Essence Exhaustion; Heart and Kidney Deficiency; Spleen and Kidney Yang Deficiency; Liver and Kidney Yin Deficiency. Treatment follows the pattern a patient presents with, not the Western diagnosis alone.

When to get help: An adrenal crisis (severe vomiting, abdominal pain, confusion, collapse or very low blood pressure) is a medical emergency; call emergency services and use emergency hydrocortisone if prescribed. Never stop or reduce steroid replacement in favour of herbs, and check with your doctor before taking liquorice, which alters steroid and salt balance.