Addison's disease treatment
Lifelong steroid hormone replacement and emergency planning to replace the hormones the adrenal glands can no longer make, led by an endocrine team.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Addison's disease is treated with lifelong steroid hormone replacement, usually hydrocortisone and often fludrocortisone, to replace what the adrenal glands cannot make.
- Treatment replaces missing hormones rather than curing the cause, so it is taken every day for life.
- Knowing your 'sick day rules' and carrying a steroid emergency card is essential, because illness or injury can trigger a life-threatening adrenal crisis.
- Care should be led by an endocrine team, with a clear emergency plan you and those close to you understand.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Replaces the hormones the adrenal glands can no longer make
Stopping or pausing steroid replacement abruptly is never appropriate, as it can trigger a life-threatening crisis.
Many people feel noticeably better as cortisol and salt levels are restored. The team checks how you are responding and fine-tunes doses.
A named endocrine team and a clear route to contact them, including when unwell.
Many people feel noticeably better as cortisol and salt levels are restored. The team checks how you are...
Doses of hydrocortisone and fludrocortisone are adjusted using your symptoms, blood pressure and blood tests to...
Reviews check wellbeing, blood pressure, salts and dosing, and refresh your sick day and emergency plan.
You follow your sick day rules, increasing your dose, and use an emergency injection and seek help if you cannot...
What is Addison's disease treatment?
Addison's disease, also called primary adrenal insufficiency, means the adrenal glands do not make enough of certain hormones, especially cortisol and often aldosterone. Cortisol helps the body cope with stress, illness and blood sugar; aldosterone helps control salt, water and blood pressure. The most common cause in the UK is the immune system damaging the adrenal glands.
The main treatment is to replace the missing hormones with daily steroid medicine, usually hydrocortisone, and often a second tablet called fludrocortisone. This is taken for life. Treatment does not cure the underlying problem but replaces what the body can no longer make, allowing people to live well.
A crucial part of treatment is knowing what to do when you are ill, injured or having an operation, because the body normally makes extra cortisol at these times. People with Addison's disease need to increase their steroid dose ('sick day rules') and, if very unwell, may need an emergency injection.
This guide explains the treatment, the sick day rules, emergency planning, and how the condition is monitored. It is general information, not a personal dosing plan, which only your endocrine team can give you.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Glucocorticoid replacement (cortisol)
Usually hydrocortisone, taken as tablets split through the day to mimic the body's natural pattern. Some people use a modified-release form. This replaces cortisol, the main...
Mineralocorticoid replacement (aldosterone)
Fludrocortisone tablets, often needed in Addison's disease, to help control salt, water and blood pressure. The dose is adjusted using blood pressure and blood tests.
Sick day dosing
A plan to increase your steroid dose during illness, fever, injury or before procedures, because the body cannot make extra cortisol on its own.
Emergency injection
An injectable hydrocortisone kit for use if you cannot keep tablets down or become very unwell, alongside calling for urgent help.
Preparing for your treatment
- Ask to be looked after by an endocrine team experienced in adrenal insufficiency.
- Make sure you understand your daily doses and the exact times to take them.
- Get and carry a steroid emergency card, and consider a medical alert bracelet or necklace.
- Ask to be taught your sick day rules and how to use an emergency hydrocortisone injection.
- Keep a good supply of your medicines at home; patient groups suggest having an extra reserve in case of illness or shortage.
- Tell people close to you about your condition and what to do in an emergency.
- Mention any other conditions or medicines, as some interact with steroid replacement.
What happens
Diagnosis usually involves blood tests for cortisol and salts, and a short Synacthen test, where cortisol is measured before and after an injection that should stimulate the adrenal glands. A poor cortisol response, with other results, points to Addison's disease.
Once diagnosed, you are started on steroid replacement, usually hydrocortisone split through the day, and often fludrocortisone. The endocrine team teaches you how to take it, your sick day rules, and how to use an emergency injection.
At reviews, the team checks your symptoms, blood pressure and blood tests, and adjusts doses. Because cortisol levels cannot be matched perfectly by tablets, the aim is the lowest dose that keeps you well, avoiding both too little (tiredness, dizziness, crisis) and too much (weight gain, raised blood sugar, thinning bones).
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Stopping or pausing steroid replacement abruptly is never appropriate, as it can trigger a life-threatening crisis.
- Managing Addison's disease without a specialist team and a clear emergency plan is not safe.
- Relying on standard doses during illness instead of personalised sick day rules can be dangerous.
- Using replacement steroids as a 'tonic' or in higher doses than needed risks long-term steroid side effects.
Delay or rearrange if…
- Do not delay treatment if you are unwell — an adrenal crisis is an emergency.
- Dose adjustments and reviews should not wait if you are having frequent symptoms of under- or over-replacement.
- Before surgery or major dental work, make sure a steroid cover plan is in place first.
- If you are acutely unwell or vomiting, follow your emergency plan rather than waiting for a routine appointment.
Alternatives to discuss
- There is no safe alternative to steroid hormone replacement in true adrenal insufficiency; it replaces an essential hormone.
- Different glucocorticoid options (such as modified-release hydrocortisone) may suit some people better.
- Adjusting the timing and split of doses to improve how you feel through the day.
- Considering DHEA in selected cases, decided with a specialist, where wellbeing is poor despite good cortisol replacement.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Replaces the hormones the adrenal glands can no longer make
- Relieves symptoms such as tiredness, weakness, dizziness, nausea and low blood pressure
- Allows most people to live a full, active life
- With sick day rules and an emergency kit, greatly reduces the risk of a life-threatening crisis
- Regular reviews help find the lowest dose that keeps you well
Risks & complications
- Needing to take tablets several times a day, every day, for life
- Having to adjust doses during illness, stress or before procedures
- Symptoms returning if doses are missed, vomited up or too low
- Regular reviews and blood tests
- Too much steroid over time causing weight gain, raised blood sugar, bone thinning or skin changes
- Too little steroid causing tiredness, dizziness, nausea and low blood pressure
- Salt and blood pressure problems if fludrocortisone dosing is not quite right
- Other autoimmune conditions, such as thyroid problems, which are more common in Addison's disease
- Adrenal crisis — a medical emergency with collapse, severe weakness, vomiting and low blood pressure
- Severe illness if sick day rules are not followed during infection or injury
The most important risk in Addison's disease is an adrenal crisis, which can be life-threatening and is most likely during illness, vomiting, injury or surgery, or if doses are missed. This is why sick day rules, an emergency injection and a steroid emergency card matter so much. Ask your team to make sure you, and someone close to you, know exactly what to do in an emergency.
Published figures to discuss
Most risk in Addison's disease relates to adrenal crisis and to the long-term effects of getting the steroid dose wrong, rather than to a single procedure. Crisis rates vary with how well sick day rules and emergency planning are understood and followed, so reliable numbers are hard to apply to any one person. We have therefore kept this qualitative.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Adrenal crisis | Life-threatening emergency, but preventable risk is reduced by sick-day rules and emergency hydrocortisone | Society for Endocrinology emergency guidance uses immediate 100 mg hydrocortisone IM/IV when adrenal crisis is suspected in adults. | Addison's disease: identification and management in primary care — PMCncbi.nlm.nih.govSource-linked context |
| Vomiting or diarrhoea while steroid-dependent | High-risk situation | Oral tablets may not be absorbed. Patients need an injection plan, emergency card and a low threshold for urgent care. | Addison's disease: identification and management in primary care — PMCncbi.nlm.nih.govSource-linked context |
| Under-replacement | Recognised | Weight loss, dizziness, fatigue, salt craving, low blood pressure or recurrent illness should trigger dose and diagnosis review. | Guide sourcesClinical context |
| Over-replacement | Recognised | Too much steroid over time can contribute to weight gain, hypertension, diabetes, bruising and bone loss. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Addison's disease is a lifelong condition, so the focus is on how you respond to treatment and on ongoing monitoring rather than a one-off recovery. Most people feel much better once replacement is started and the dose is right for them.
- Feeling much better once replacement is started and the dose is right
- Some trial and error while doses are adjusted
- Needing to plan medicines around work, travel and time zones
- Temporarily increasing your dose during illness, then returning to your usual dose
- Mild tiredness if a dose is late, easing once it is taken
Aftercare
- Take your steroid medicine exactly as prescribed and never stop it suddenly.
- Always carry your steroid emergency card, and wear a medical alert if you can.
- Follow your sick day rules: increase your dose for fever or significant illness as advised.
- Keep an in-date emergency hydrocortisone injection and know how to use it.
- Keep a good supply of medicine at home, with a reserve for illness or shortages.
- Tell every clinician, dentist and pharmacist that you have adrenal insufficiency.
- Plan ahead for travel, time-zone changes, vaccinations and any operations.
- Steroid emergency card on you at all times
- Medical alert bracelet or necklace if possible
- Written sick day rules you understand
- In-date emergency hydrocortisone injection kit
- A reserve supply of your usual medicines
- Someone close to you who knows your emergency plan
- Contact details for your endocrine team
⚠ Get urgent help if…
- Severe weakness, dizziness, confusion or collapse — this may be an adrenal crisis; call for emergency help.
- Repeated vomiting or diarrhoea so you cannot keep your tablets down — use your emergency injection and seek urgent help.
- A high fever or serious infection where you are unsure how to adjust your dose.
- Severe drowsiness, very low blood pressure or fast heartbeat.
- Any major injury, accident or need for surgery — extra steroid is needed.
- Feeling increasingly unwell despite taking your usual dose.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result is feeling well day to day, with normal energy and blood pressure, on the lowest steroid dose that keeps your symptoms away. Most people with Addison's disease live full lives once replacement is in place and they are confident with sick day rules.
Treatment does not cure the condition or restore the adrenal glands, and it cannot perfectly match the body's natural cortisol rhythm, so some fine-tuning is normal. The key measure of success is that you feel well and that crises are prevented through good emergency planning.
Addison's disease needs lifelong treatment. With the right replacement, sick day rules and emergency planning, most people do very well, but the condition itself does not go away and steroids must never be stopped suddenly. Over time, doses may need adjusting, and because other autoimmune conditions are more common, your team may check for these. Good education and a clear emergency plan are the strongest protection against adrenal crisis.
Related tests, treatments or support
Because Addison's disease is linked with other autoimmune conditions, your team may check for problems such as an underactive thyroid, type 1 diabetes or coeliac disease. If found, these are managed alongside your steroid replacement. Some people have adrenal insufficiency as part of a wider pituitary problem, in which case other hormone replacements may also be needed.
Follow-up & long-term care
Follow-up is led by your endocrine team, usually once or twice a year when you are stable. Reviews check your symptoms, blood pressure, salts and dosing, screen for related conditions where appropriate, and refresh your sick day and emergency plan. You should also have a clear route to contact the team if you become unwell or are unsure about dosing.
- Lifelong daily steroid replacement, with doses adjusted over time
- Regular blood pressure checks and blood tests for salts
- Keeping an in-date emergency hydrocortisone injection
- Carrying a steroid emergency card and wearing a medical alert
- Periodic checks for related autoimmune conditions
- Bone health review where long-term steroid effects are a concern
Repeat, follow-on and what comes next
- Doses are commonly adjusted over time as needs change with age, weight, illness and activity.
- Sick day rules are temporary increases that should be followed each time you are unwell, then reversed.
- Some people switch between glucocorticoid preparations to feel better.
- Reassessment for related autoimmune conditions may be needed over the years.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A named endocrine team and a clear route to contact them, including when unwell.
- Written, personalised sick day rules and an in-date emergency injection kit.
- A steroid emergency card and advice to wear a medical alert.
- Education for the patient and someone close to them on recognising and treating a crisis.
- Planned reviews of dose, blood pressure, salts and related conditions, plus bone health where relevant.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether care is a one-off second opinion or ongoing specialist management
- The number and frequency of clinic reviews
- Blood tests for cortisol, salts and related conditions
- Any diagnostic tests, such as a short Synacthen test
- Education and supply of an emergency hydrocortisone injection kit
- Bone health review if long-term steroid effects are a concern
- The specialist (endocrinologist) fee and how many reviews are included
- The cost of blood tests and diagnostic tests and who reports them
- Whether steroid education and an emergency kit are provided
- How prescriptions and medicine supply are arranged
- What is included for sick day and emergency planning
- What happens, and what it costs, in an urgent deterioration or crisis
- Whether long-term care would transfer to the NHS
On the NHS? Addison's disease is usually managed on the NHS by an endocrine team; private care is sometimes used for a faster first appointment or a second opinion, but long-term care and emergency planning are specialist-led.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being taught clear, personalised sick day rules.
- Being discharged without a steroid emergency card or an emergency injection plan.
- No discussion of the dangers of stopping steroids suddenly.
- Not being told that other clinicians, including dentists, must know about the condition.
- Over-replacement being missed, leading to avoidable long-term steroid side effects.
Marketing red flags
- Claims of a 'natural' cure or that supplements can restore adrenal function in true Addison's disease.
- Confusing Addison's disease with unproven 'adrenal fatigue' diagnoses.
- Offering high-dose steroid 'boosts' without proper monitoring.
- Downplaying the need for lifelong treatment and emergency planning.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What is my exact daily dose, and when should I take each tablet?
- What are my sick day rules, and at what point do I increase my dose?
- How and when should I use my emergency hydrocortisone injection?
- How will my dose be checked and adjusted over time?
- Should I be checked for other autoimmune conditions?
- What do I need to arrange before surgery, travel or vaccinations?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Can Addison's disease be cured?
What are 'sick day rules'?
What is an adrenal crisis?
Why do I need to carry a steroid emergency card?
Is treatment available on the NHS?
Can I still travel, exercise and work normally?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Addison's disease: Treatment NHS — Addison's disease: Diagnosis Society for Endocrinology — Adrenal crisis Society for Endocrinology — Steroid medicine and sick day rules (PDF) Addison's disease: identification and management in primary care — PMC Diagnosis and treatment of primary adrenal insufficiency — Endocrine Society guideline (PMC)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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