Epidemiology, pathogenesis, and diagnosis of Addison's disease in adults

J Endocrinol Invest. 2019 Dec;42(12):1407-1433. doi: 10.1007/s40618-019-01079-6. Epub 2019 Jul 18.


Background: Addison's disease (AD) is a rare disorder and among adult population in developed countries is most commonly caused by autoimmunity. In contrast, in children genetic causes are responsible for AD in the majority of patients.

Purpose: This review describes epidemiology, pathogenesis, genetics, natural history, clinical manifestations, immunological markers and diagnostic strategies in patients with AD. Standard care treatments including the management of patients during pregnancy and adrenal crises consistent with the recent consensus statement of the European Consortium and the Endocrine Society Clinical Practice Guideline are described. In addition, emerging therapies designed to improve the quality of life and new strategies to modify the natural history of autoimmune AD are discussed.

Conclusions: Progress in optimizing replacement therapy for patients with AD has allowed the patients to lead a normal life. However, continuous education of patients and health care professionals of ever-present danger of adrenal crisis is essential to save lives of patients with AD.

Keywords: Addison’s disease; Autoimmune polyendocrine syndromes; Natural history of Addison’s disease; Primary adrenal insufficiency; Therapy of Addison’s disease.

Publication types

  • Review

MeSH terms

  • Addison Disease / diagnosis*
  • Addison Disease / drug therapy
  • Addison Disease / epidemiology*
  • Addison Disease / etiology
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Age Factors
  • Female
  • Hormone Replacement Therapy*
  • Humans
  • Incidence
  • Male
  • Prevalence
  • Quality of Life
  • Sex Factors


  • Adrenal Cortex Hormones