Addison's disease (adjunct)
Also known as: Addison's disease, primary adrenal insufficiency, primary hypoadrenalism, autoimmune adrenalitis, adrenocortical insufficiency
Addison's disease is primary adrenal insufficiency caused by damage or dysfunction of the adrenal cortex, resulting in inadequate cortisol production and commonly inadequate aldosterone production. Causes include autoimmune adrenalitis, infection, adrenal haemorrhage, infiltrative disease, genetic disorders, malignancy and surgical removal of the adrenal glands. Symptoms may develop gradually and include persistent fatigue, muscle weakness, loss of appetite, weight loss, abdominal discomfort, nausea, vomiting, diarrhoea, salt craving, low blood pressure, postural dizziness and increased skin or mucosal pigmentation. Diagnosis and long-term management require endocrinological assessment, hormone testing and lifelong glucocorticoid replacement, with mineralocorticoid replacement usually required in primary adrenal insufficiency. Acute illness, vomiting, trauma, surgery, dehydration or missed steroid doses can precipitate adrenal crisis, a rapidly fatal emergency requiring immediate hydrocortisone and intravenous fluid treatment. TCM descriptions may overlap with Spleen and Kidney Yang deficiency, Kidney Qi deficiency, Qi and Blood deficiency, Spleen Qi deficiency with Dampness, or Yin-fluid depletion after prolonged illness. Acupuncture and Chinese herbal medicine may be considered only as adjuncts for medically stable symptoms such as fatigue, appetite disturbance, sleep difficulty or musculoskeletal discomfort. They must never replace hormone replacement, sick-day steroid dosing, emergency hydrocortisone injection, electrolyte management or specialist care.
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Lifestyle & Diet
- •Take hydrocortisone, cortisone acetate, prednisolone, fludrocortisone or other prescribed replacement exactly as directed.
- •Never abruptly stop prescribed glucocorticoid replacement.
- •Follow the endocrinologist's written sick-day rules during fever, infection, injury, surgery, vomiting or other physiological stress.
- •Keep an emergency hydrocortisone injection kit accessible and ensure the patient and close contacts are trained to use it according to the medical plan.
- •Carry medical identification or a steroid emergency card indicating adrenal insufficiency.
- •Keep spare medication available when travelling and carry it in hand luggage rather than checked baggage.
- •Discuss time-zone changes and dosing schedules with the treating clinician before long-distance travel.
- •Seek urgent help when vomiting prevents retention of oral steroid medication.
- •Maintain fluid and salt intake according to the endocrinologist's instructions, particularly during heat, exercise or gastrointestinal illness.
- •Do not substantially increase salt intake without advice when hypertension, heart failure, kidney disease or another contraindication is present.
- •Avoid prolonged fasting, crash diets and severe carbohydrate restriction unless supervised by a clinician familiar with adrenal insufficiency.
- •Eat regular balanced meals when this helps prevent weakness or hypoglycaemic symptoms.
- •Increase physical activity gradually and avoid pushing through marked dizziness, weakness or illness.
- •Plan additional precautions for strenuous exercise, hot weather, altitude, remote travel and situations with limited emergency access.
- •Tell surgeons, dentists, anaesthetists and other clinicians about adrenal insufficiency before procedures because stress-dose glucocorticoids may be required.
- •Pregnancy planning and antenatal care should involve clinicians experienced in adrenal insufficiency.
- •Monitor blood pressure, electrolytes, weight, symptoms and replacement adequacy according to specialist recommendations.
- •Do not use over-the-counter adrenal-support or adrenal-fatigue supplements as substitutes for prescribed hormones.
- •Check supplements for undisclosed steroids, glandular extracts, liquorice or stimulants.
- •Seek medical review for increasing fatigue, weight loss, nausea, salt craving, dizziness or pigmentation because these may indicate under-replacement or disease progression.
- •Seek review for weight gain, insomnia, swelling, hypertension, easy bruising or glucose changes because these may indicate glucocorticoid or mineralocorticoid over-replacement.
- •Provide family members, colleagues or travel companions with a clear emergency plan where appropriate.
Cautions & Contraindications
- •Do not replace hydrocortisone, prednisolone, cortisone acetate or fludrocortisone with acupuncture or herbal medicine.[,]
- •Do not reduce or discontinue prescribed steroid replacement without endocrinology supervision.[,]
- •Do not use the term 'adrenal fatigue' as an alternative diagnosis for Addison's disease or unexplained tiredness.[]
- •Do not delay emergency hydrocortisone and intravenous fluids while attempting acupuncture, herbal treatment or oral rehydration in suspected adrenal crisis.[,]
- •Do not give oral herbs, food or fluids to a confused, unconscious, severely vomiting or aspiration-risk patient.[,]
- •Do not provide routine outpatient acupuncture during hypotension, shock, persistent vomiting, severe diarrhoea, high fever, sepsis, hypoglycaemia or altered consciousness.[,,]
- •Avoid strong purgative, emetic, diuretic or sweating-inducing formulas because they may worsen dehydration and electrolyte disturbance.
- •Avoid unmonitored liquorice or high-dose Gān Cǎo. Glycyrrhizin can cause hypertension, sodium retention, hypokalaemia and interactions relevant to steroid and mineralocorticoid therapy.
- •Fù Zǐ must be correctly processed and is inappropriate for unsupervised use because serious cardiotoxicity and neurotoxicity may occur.
- •Avoid Fù Zǐ in cardiac arrhythmia, severe hypertension, pregnancy or when correct processing and dosing cannot be verified.
- •Review Rén Shēn and other stimulating tonics for interactions, insomnia, hypertension and glucose effects.
- •Dāng Guī, Chuān Xiōng and other Blood-moving herbs require caution with pregnancy, bleeding disorders and anticoagulant therapy.
- •Avoid nephrotoxic, hepatotoxic, aristolochic-acid-containing, contaminated or incorrectly identified herbs.
- •Do not recommend glandular adrenal extracts or supplements containing undisclosed corticosteroids.[]
- •Do not independently alter salt, potassium or fluid intake in a patient taking fludrocortisone or with renal or cardiovascular disease.[]
- •Do not assume hyperpigmentation is a TCM Blood-stasis sign without recognising its biomedical relevance to primary adrenal insufficiency.[,]
- •Do not attribute worsening fatigue, nausea or dizziness to a 'healing reaction'.[]
- •Do not perform prolonged fasting, detoxification, colonic irrigation, forced sweating or extreme exercise programs.
- •Do not claim that acupuncture or herbs regenerate the adrenal cortex, cure autoimmune adrenalitis or eliminate the need for lifelong replacement therapy.[,]
- •Do not use symptom improvement as evidence that hormone levels, blood pressure or electrolytes are normal.[]
- •Confirm the patient has diagnosed, medically managed adrenal insufficiency before providing adjunctive treatment.[,]
- •Do not administer prescription hydrocortisone unless trained, authorised and acting within professional scope and applicable emergency protocols.[,]
- •Postural hypotension increases syncope risk — check clinical stability, use supine or supported positioning and allow slow transitions after treatment.[]
- •Avoid strong stimulation, prolonged sessions or large numbers of needles in markedly fatigued, hypotensive, dehydrated or underweight patients.[]
- •Avoid abdominal needling during unexplained severe abdominal pain or suspected adrenal crisis.[]
- •Use caution with moxibustion and heat therapy because overheating and dehydration can increase physiological stress.[]
- •Review anticoagulant use, skin fragility, immunosuppression, diabetes and delayed wound healing before needling.[]
- •Use sterile single-use needles and recognised infection-control procedures; follow WHO standard point locations.[,]
- •Temporary improvement in fatigue or nausea does not demonstrate correction of cortisol or aldosterone deficiency.[,]
When to reassess or seek care again
- •Immediate emergency reassessment for any suspected adrenal crisis — parenteral hydrocortisone and IV saline take priority over investigation.[,]
- •Within 24 hours: reassess any acute intercurrent illness, vomiting, injury or missed dose to confirm sick-day dosing has been applied correctly.[,]
- •At 1–2 weeks: review symptoms, blood pressure, weight, salt craving and postural symptoms as markers of replacement adequacy.[,]
- •At 3 months and then 6–12 monthly: specialist endocrine review of glucocorticoid and mineralocorticoid dosing, electrolytes and comorbidities.[,]
- •Review TCM pattern every 2–4 weeks in stable adjunctive care; shifts between Yang deficiency, Qi-Blood deficiency and Yin depletion require a change in point and formula strategy.
- •Intercurrent infection, fever, gastroenteritis, dental or surgical procedures without stress-dose cover.[,]
- •Missed, delayed or vomited glucocorticoid dose.[,]
- •Dehydration, heat exposure, strenuous exercise, altitude or long-distance travel across time zones.[]
- •Pregnancy, labour and the puerperium — replacement requirements change and must be specialist-managed.[]
- •Major emotional or physical stress, trauma or sleep deprivation.[,]
- •Use of liquorice, glandular extracts or interacting supplements that alter cortisol metabolism or electrolytes.
Adjunctive TCM must be paused and the patient redirected to emergency care at any sign of adrenal crisis. Symptomatic improvement never substitutes for biochemical monitoring of cortisol and electrolyte replacement adequacy.
Frequently Asked Questions
What is Addison's disease?+
Addison's disease is primary adrenal insufficiency in which the adrenal glands do not produce enough cortisol and commonly do not produce enough aldosterone. It requires medical diagnosis and lifelong hormone-replacement management [8].
What symptoms can occur with Addison's disease?+
Symptoms may include chronic fatigue, muscle weakness, reduced appetite, weight loss, abdominal discomfort, nausea, salt craving, low blood pressure, postural dizziness and increased skin or mucosal pigmentation [8].
What is an adrenal crisis?+
An adrenal crisis is an acute, potentially fatal shortage of cortisol that can cause severe weakness, vomiting, abdominal pain, hypotension, confusion, hypoglycaemia, electrolyte disturbance, shock or unconsciousness [8].
How is suspected adrenal crisis treated?+
It requires immediate emergency treatment. Specialist guidance recommends prompt parenteral hydrocortisone and rapid intravenous saline rather than waiting for diagnostic confirmation [8].
Can acupuncture replace hydrocortisone or fludrocortisone?+
No. Acupuncture cannot replace glucocorticoid or mineralocorticoid replacement and must never delay sick-day dosing or emergency hydrocortisone [8].
Can Chinese herbs cure Addison's disease?+
There is no established evidence that Chinese herbs restore destroyed adrenal tissue or remove the need for hormone replacement. Herbal treatment may only be considered adjunctively after interaction and safety review [8].
What TCM patterns may be considered?+
Traditional patterns may include Spleen-Kidney Yang deficiency, Kidney Qi deficiency, Spleen Qi deficiency, Qi-Blood deficiency, Yin-fluid deficiency or Liver-Spleen disharmony. These patterns do not diagnose adrenal insufficiency [8].
Which acupuncture points may be considered in stable patients?+
Pattern-dependent points may include ST36, SP6, REN6, REN4, BL20, BL23, KI3, PC6 and HT7. Treatment should be gentle, particularly when hypotension or fatigue is present [8].
Why is liquorice important in Addison's disease herbal safety?+
Liquorice and concentrated Gān Cǎo can affect sodium, potassium, blood pressure and steroid metabolism. They must not be used as substitutes for fludrocortisone and require clinician and pharmacist review [8].
What should a patient with adrenal insufficiency carry?+
Patients are generally advised to carry medical identification, prescribed steroid medication and an emergency hydrocortisone kit, with training for themselves and close contacts [8].
Is adrenal fatigue the same as Addison's disease?+
No. Addison's disease is a medically recognised hormone-deficiency disorder confirmed through appropriate testing. Adrenal fatigue is not a recognised medical diagnosis [8].
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Sources & Further Reading
Clinical guidance, red flags and safety notes on this page draw on the following current sources alongside the classical references above.
- National Institute for Health and Care Excellence · 2024
Current guidance covering identification, hormone replacement, sick-day dosing, emergency kits, adrenal-crisis management and ongoing care.
- Society for Endocrinology · 2026
Emergency guidance recommending immediate parenteral hydrocortisone and rapid intravenous saline for suspected adrenal crisis.
- Healthdirect Australia · 2026
Australian overview of causes, symptoms, diagnosis and treatment of Addison's disease.
- Healthdirect Australia · 2026
Australian information on adrenal hormones and symptoms of primary adrenal insufficiency.
- National Institute of Diabetes and Digestive and Kidney Diseases · 2026
Authoritative definition and distinction between primary and secondary adrenal insufficiency.
- National Institute of Diabetes and Digestive and Kidney Diseases · 2026
Clinical symptoms and recognised causes of adrenal insufficiency.
- Royal Australian College of General Practitioners · 2010
Australian primary-care review of diagnosis, steroid replacement and emergency management.
- World Health Organization · 2008
Standardised acupuncture-point nomenclature and anatomical-location methodology.
- World Health Organization · 2020
International benchmarks covering minimum requirements and safe acupuncture practice.
Educational reference for licensed practitioners. Not a substitute for individual clinical assessment. Refer to conventional care for any red-flag or undiagnosed presentation.