Is anemia a sign of adrenal insufficiency (Addison's disease)?

From the Guidelines

Anemia can be a sign of adrenal insufficiency, as it is mentioned in the consensus statement on the diagnosis, treatment, and follow-up of patients with primary adrenal insufficiency 1.

Key Points to Consider

• The adrenal glands produce hormones such as cortisol and aldosterone, which play crucial roles in various bodily functions, including red blood cell production and maintenance.
• A deficiency in these hormones, as seen in adrenal insufficiency, can lead to anemia, among other symptoms.
• According to the study, anemia, mild eosinophilia, lymphocytosis, and increased liver transaminases may be present in patients with adrenal insufficiency 1.

Diagnosis and Treatment

• Diagnostic testing for adrenal insufficiency should include morning cortisol levels, ACTH stimulation tests, and possibly measurement of ACTH levels to distinguish between primary and secondary adrenal insufficiency.
• Treatment involves hormone replacement with glucocorticoids, typically hydrocortisone 15-25 mg daily in divided doses, and sometimes mineralocorticoids, such as fludrocortisone 0.05-0.2 mg daily, for primary adrenal insufficiency 1.

Important Considerations

• Patients with adrenal insufficiency should be educated on managing daily medications and situations of minor to moderate concurrent illnesses, and should wear Medic Alert identification jewelry and carry a steroid/alert card 1.
• The lowest dose of hormone replacement therapy compatible with health and a sense of well-being should be used, and patients should be monitored for complications of glucocorticoid therapy, including bone mineral density every 3-5 years 1.

From the Research

Adrenal Insufficiency and Anemia

• Adrenal insufficiency is a condition characterized by inadequate glucocorticoid production, which can lead to various symptoms, including fatigue, anorexia, and orthostasis 2, 3.
• The diagnosis of adrenal insufficiency is made by demonstrating low basal and/or stimulated serum cortisol, and should be followed by appropriate investigations to establish the underlying aetiology 2.
• Anemia is not explicitly mentioned as a sign of adrenal insufficiency in the provided studies, but fatigue is a common symptom, which can be related to anemia 3, 4.
• The clinical manifestations of adrenal insufficiency can be subtle and non-specific, making it challenging to diagnose, and a high clinical suspicion is needed to avoid misdiagnosing a life-threatening adrenal crisis 3, 5.

Diagnosis and Management

• The diagnosis of adrenal insufficiency is based on measurement of the adrenal corticosteroid hormones, their regulatory peptide hormones, and stimulation tests 5.
• The goal of therapy is to establish a hormone replacement regimen that closely mimics the physiological diurnal cortisol secretion pattern, tailored to the patient's daily needs 5.
• Patient education is a key feature of management of adrenal insufficiency, and regular monitoring for features of under- and over-replacement is essential during follow-up 2, 6.

Related Conditions

• Addison's disease, also known as primary adrenal insufficiency, is a rare condition caused by the autoimmune destruction of the adrenal cortex, and requires lifelong replacement with glucocorticoids and mineralocorticoids 4, 6.
• Secondary adrenal insufficiency is more frequent and is caused by diseases affecting the pituitary, whereas in tertiary adrenal insufficiency, the hypothalamus is affected 5.