Therapy

Since in Addison’s disease the adrenal glands are destroyed and cannot regenerate, this disease cannot be cured. However, it can be treated well with a lifelong therapy. It is necessary to supply the hormones, which are no longer produced sufficiently by the adrenal glands, from outside (substitution).

As a rule, both glucocorticoids (cortisol) and mineral corticoids (aldosterone) must be substituted. Since it is very important to take the correct dose of hormones, the amount of hormones taken must be precisely adjusted and regular follow-ups by the treating physician are necessary. Cortisol is most produced and released into the bloodstream in healthy people in the morning.

Hormone replacement therapy is adjusted to this rhythm and the largest amount of cortisol replacement products is taken in the morning. In most cases hydrocortisone in the form of tablets is used for this purpose. In the event of existing stress, such as an infection or an operation, the amount must be temporarily increased.

If this is not done, in the worst case this can lead to a life-threatening Addison crisis with circulatory failure. Fludrocortisone is usually used as a replacement for aldosterone. This ensures, just as aldosterone normally does, that the blood pressure is regulated.

How should one manage Addison’s disease?

A healthy diet with a low proportion of quickly digestible sugars or carbohydrates is recommended in Addison’s disease. Carbohydrates from white sugar or fructose cause blood sugar to rise rapidly, and the body must then release the messenger substance insulin. When large quantities of sweets are consumed, a large amount of insulin is released, which can then lead to a very rapid drop in sugar.

In such cases, the body actually reacts by releasing cortisol to activate stored sugar reserves and thus counteract the falling levels. Due to the insufficiency of the adrenal gland, however, it can only react to a limited extent and is also heavily loaded. For this reason, it is advisable to eat carbohydrates that cause a slow increase in blood sugar, such as brown rice or wholemeal pasta. In addition to “good” carbohydrates, vegetables, omega-3 fatty acids and proteins such as those found in fish and lean meat are of course also among the foods that should be at the top of the menu for Addison’s disease.