Addison's disease treatment: what works and why

If you’ve been told you have Addison’s disease, the first thing to know is that treatment isn’t a mystery. It’s mostly about replacing the hormones your adrenal glands can’t make. Most people stay steady on a daily dose of hydrocortisone or a similar steroid, plus a tiny amount of fludrocortisone to keep blood pressure and sodium in check.

Getting the right dose is a bit of trial‑and‑error. Your doctor will start with a low dose, watch how you feel, and adjust. You’ll notice you feel more normal when you can get up without dizziness, have steady energy, and no weird cravings for salty foods. Keep a simple journal of how you feel after each dose – that helps your doctor fine‑tune the plan.

First steps: hormone replacement

Hydrocortisone is the backbone of treatment. Most adults take 15‑30 mg split into two or three doses a day. Morning dose is the biggest, because that mimics natural cortisol peaks. Some people use a longer‑acting steroid like prednisone if it fits their schedule better, but they usually need a slightly lower dose.

Fludrocortisone is the sidekick. A tiny tablet (usually 0.05‑0.2 mg) helps your kidneys hold onto sodium and get rid of potassium. If you still feel light‑headed or have low blood pressure even on the right steroid dose, ask your doctor to check your fludrocortisone – you might need a little more.

Managing stress and daily life

Stress, illness, or injury makes your body need more cortisol. The rule of thumb is to double or triple your hydrocortisone dose when you have a fever, major surgery, or a severe infection. Keep an emergency injection kit (usually Solu‑Cortef) at home, work, and in your bag. The kit comes with a short needle and a syringe – you can give yourself a 100 mg injection if you can’t keep food down or you collapse.

Wear a medical alert bracelet that says “Addison’s disease – needs steroids”. It can be a lifesaver if you’re unconscious and first responders need to know your condition fast.

Don’t skip meals. Your steroid dose works best when you eat regularly. Low blood sugar can make you feel shaky and increase the chance of an adrenal crisis. Carry a snack like a granola bar or a piece of fruit for those moments when a meal is delayed.

Stay hydrated, especially in hot weather or when you’re exercising. Drinking enough water supports the fludrocortisone effect and helps keep blood pressure stable. If you’re sweating a lot, a pinch of salt in your water can help balance electrolytes.

Regular check‑ups are key. Your doctor will test blood pressure, electrolytes, and sometimes a morning cortisol level. If anything looks off, they might tweak your dose. Most people with Addison’s disease live normal lives – the treatment may feel like a routine, but it’s what keeps the body running smoothly.

Bottom line: stick to your daily steroid, have an emergency plan, and watch for stress triggers. With those basics, you can manage Addison’s disease without it running your day.