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Diabetes and adrenal gland failure

Failure of the adrenal glands located on top of the kidneys i.e. Addison’s disease is rare but it is roughly ten times more common in people with type 1 diabetes.

In the anatomical structure of the kidney, the adrenal gland is located on top of the kidney.

Addison’s disease is where the adrenal glands located on the top of your kidneys do not produce enough hormones. The adrenal glands produce cortisol and aldosterone, the stress hormone and the hormone that regulates sodium, respectively, as well as small amounts of dehydroepiandrosterone, which is similar to male sex hormone.

In Addison’s disease, the body starts to produce antibodies against the cells of the adrenal glands. As a result, the cells that produce cortisol and aldosterone are gradually destroyed, resulting in adrenal gland failure.

In Finland, Addison’s disease is diagnosed with approximately 50–70 people each year. According to the Finnish FinnDiane research, the incidence rate of Addison’s disease in adults with type 1 diabetes was 0.4 per cent, whereas it was 0.02 per cent amongst the control group.

As a result of the lack of cortisol and aldosterone, the body’s overall ability to perform is significantly diminished. In some cases, the disease starts with a sudden crisis, a shock characterised by a drop in blood pressure, vomiting, stomach pain and disturbances of consciousness.

Untreated, Addison’s disease in a person with diabetes can lead to the blood sugar level dropping too low at night. The sodium level, potassium level and blood pressure of a person with diabetes are monitored in the annual check-ups. Any anomalies in the above may indicate Addison’s disease. More specific hormone definitions are performed in further examinations.

Possible symptoms of Addison's disease

The symptoms include tiredness, lack or energy, weight loss, lack of appetite, nausea or vomiting, weakness, a craving for salt, low blood pressure, disturbances of the menstrual cycle, erectile dysfunction, mood swings and a darkening of the skin.

Treatment of Addison's disease

In Addison’s disease, the missing hormones must be replaced, which normally means taking hydrocortisone and fludrocortisone pills.

Replicating the normal release of cortisol, hydrocortisone is taken in three or sometimes two doses per day.

In stressful situations, such as in connection with infections, the hydrocortisone dose is doubled. In the case of vomiting, dehydration, a crisis requiring A&E or surgery, hydrocortisone must be given intravenously or intramuscularly.

Late in a pregnancy, the hydrocortisone – and sometimes also the fludrocortisone – dose of a person with Addison’s disease is slightly increased.

Updated 8.11.2023