Addison’s Disease vs. Cushing’s Syndrome: What's the Difference?

Medically reviewed on December 10, 2023 by Jillian Foglesong Stabile, MD, FAAFP. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

• Understanding Addison’s Disease
• Understanding Cushing’s Syndrome
• How Are Addison’s Disease And Cushing’s Syndrome Similar?
• Key Differences: Addison Disease vs. Cushing Syndrome
• Which Treatment Options May be Right For You?
• Learn More About Your Health With Everlywell

The adrenal glands (two small glands located above your kidneys) are responsible for producing critical hormones like cortisol and aldosterone—but in rare cases, the adrenal glands can function abnormally.[1] Abnormal adrenal function can contribute to conditions like Addison’s disease and Cushing’s syndrome.

While both conditions are related to adrenal function, there are distinct differences in their causes, symptoms, and treatments.

In this guide, we’re breaking down Addison disease vs. Cushing syndrome in detail to help you better understand both conditions. We’ll explore the similarities and differences and explain how to find an ideal treatment route if you’re living with one of these adrenal gland disorders.

Understanding Addison’s Disease

First, let’s explore Addison’s disease—a condition that can occur when your adrenal glands don’t make enough hormones.[2]

Causes of Addison’s Disease

Addison’s disease is one of three kinds of adrenal insufficiency: primary, secondary, and tertiary.[2]

Primary adrenal insufficiency (Addison’s disease) can occur when the adrenal glands are damaged and can’t make enough cortisol and (in some cases) aldosterone. Cortisol is often called the “stress hormone,” but it also plays a key role in [2]:

• Blood pressure control
• Blood sugar regulation
• Inflammatory response
• Metabolism and energy production

Aldosterone, on the other hand, is a hormone that helps your body regulate potassium and sodium levels in your blood. Both of these minerals support normal nerve and muscle function, and potassium is key to maintaining a normal heartbeat.

But why do the adrenal glands underproduce cortisol and aldosterone in people with Addison’s disease? Autoimmune disorders are one of the most common causes of Addison’s disease—when your body’s immune system attacks its own cells, it can damage your adrenal glands and impact their function.[3] But there are other, less common culprits of Addison’s disease, too:

• Adrenal cancers
• Genetic disorders
• Adrenal bleeding
• Adrenal gland removal
• Some prescription medications

Symptoms Of Addison’s Disease

People living with Addison’s disease often experience chronic (i.e., long-lasting or near-constant) symptoms like [3]:

• Fatigue and weakness
• Weight loss
• Appetite changes
• Gastrointestinal discomfort

Less common symptoms include [3]:

• Low blood sugar (hypoglycemia)
• Low blood pressure (which can cause dizziness)
• Joint pain
• Irregular menstrual cycles
• Low sex drive
• Skin darkening at pressure points (like your elbows and knees)

People living with Addison’s disease may experience mild or moderate symptoms, but severe symptoms can occur during an adrenal crisis.[1] When our bodies undergo intense physical stress (perhaps due to an injury or illness, or after a medical procedure), we need more cortisol than usual to keep functioning normally. However, for people with Addison’s disease, insufficient cortisol production can be especially impactful in these stressful scenarios.

If you’ve received an Addison’s disease diagnosis, it’s very important to recognize the symptoms of a potential adrenal crisis, like:

• Sudden and intense pain in the lower back, legs, or abdomen
• Vomiting or diarrhea
• Disorientation or confusion
• Extreme physical weakness
• Loss of consciousness

An adrenal crisis is a healthcare emergency—one that can be fatal if left untreated.[1] In cases of adrenal crisis, healthcare providers administer corticosteroid injections, which can be lifesaving for people living with Addison’s disease or other types of adrenal insufficiency. Adrenal crises can be precipitated by a number of things, including simple illness.

Treatments For Addison’s Disease

In addition to emergency medical treatments like corticosteroid injections, there are currently two general treatments for people living with Addison’s disease [4]:

1. Cortisol replacement therapy – If your body doesn’t make enough cortisol, your healthcare provider may prescribe a corticosteroid—the most common is hydrocortisone.
2. Aldosterone replacement therapy – Not all people living with Addison’s disease experience aldosterone deficiency. But, for those who do, healthcare providers often prescribe a medication called fludrocortisone. Fludrocortisone helps your body regulate sodium and potassium.

Healthcare providers also recommend that people living with Addison’s disease carry emergency corticosteroid injections (for unexpected cases of adrenal crisis) and wear a medical alert tag with information about their condition.[1]

With regular treatments and high-quality care from healthcare providers, most people living with Addison’s disease live normal, active lives.

Understanding Cushing’s Syndrome

Now, let’s explore Cushing’s syndrome—a condition that can occur when the adrenal glands make too many hormones.[5]

Causes Of Cushing’s Syndrome

Cushing’s syndrome can occur in people whose adrenal glands make an excessive amount of cortisol over a long period of time.[5] There are two kinds of Cushing’s syndrome:

1. Endogenous Cushing’s syndrome – Endogenous Cushing’s disease can occur because something inside your body is causing your adrenal glands to overproduce cortisol. Endogenous cases are very rare, but many are caused by tumors in the pituitary gland, the adrenal glands themselves, or other places in the body.[5]
2. Exogenous Cushing’s syndrome – Exogenous Cushing’s syndrome occurs when something outside of your body causes excessive cortisol production—like taking a prescription medication. The most common cause of Cushing’s disease is long-term use of prescription medications called cortisol-like glucocorticoids. These medications are typically used to treat immune-related conditions like asthma, lupus, and rheumatoid arthritis.[5]

You may have heard Cushing’s syndrome referred to as “Cushing’s disease.” Cushing’s disease is a specific type of Cushing’s syndrome—people living with Cushing’s disease have tumors in their pituitary glands that produce too much adrenocorticotropic hormone (ACTH). ACTH signals the adrenal glands to make cortisol. So, Cushing’s disease is a type of endogenous Cushing’s syndrome.

Symptoms Of Cushing’s Syndrome

There are a few hallmark symptoms of Cushing’s syndrome:

• Unusual weight gain
• Thin legs and arms
• Increased fat at the base of your neck and around your face
• A hump between your shoulders
• Easy bruising
• Dark or highly pigmented stretch marks
• Muscle weakness

There are also a few symptoms that can affect certain groups of people living with Cushing’s syndrome [5]:

• Women may develop more facial and body hair than their peers. Women who menstruate could experience irregular periods, or their periods may stop entirely.
• Men can experience sexual symptoms like decreased fertility, low sex drive, or erectile dysfunction.
• Children could grow more slowly than their peers or develop obesity.

It’s important to note that not all people with Cushing’s syndrome experience all, some, or any of the symptoms above. This makes the condition difficult to diagnose.

Treatments For Cushing’s Syndrome

For people living with exogenous Cushing’s syndrome, healthcare providers will typically either [5]:

1. Lower the dose of any glucocorticoid medications, or
2. Replace glucocorticoids with other medications

The healthcare provider might also recommend a specific Cushing syndrome diet to help manage the condition.

For people with endogenous Cushing’s syndrome, treatment might include [5]:

1. Surgery – If you have tumors that contribute to excessive cortisol production, healthcare providers might recommend surgery to remove those tumors. These procedures are typically very successful and effective.
2. Chemotherapy or radiation – If any tumors contributing to cortisol production are cancerous, your healthcare provider may recommend completing a course of radiation or chemotherapy. In addition, radiation therapy is an option for people who can’t undergo surgery to remove tumors.
3. Adrenal gland removal – Since this is the most invasive treatment option with long-term, permanent impacts, healthcare providers only remove one or more adrenal glands completely in rare cases. People whose adrenal glands are removed often take hormone replacement medications for the rest of their lives.

How Are Addison’s Disease And Cushing’s Syndrome Similar?

Addison’s disease and Cushing’s syndrome are alike in a few ways:

1. They’re adrenal conditions – Both Addison’s disease and Cushing’s syndrome are related to your adrenal glands—small glands in the kidneys that produce cortisol, aldosterone, and other hormones.
2. Some symptoms are similar – Both Addison’s disease and Cushing’s syndrome can cause fatigue, weight irregularities, and physical changes.
3. Both can be difficult to diagnose – Both Addison’s disease and Cushing’s syndrome can be difficult for healthcare providers to diagnose because symptoms don’t always present clearly (if at all).[6]
4. Both are treatable – While Cushing’s syndrome and Addison’s disease can produce uncomfortable symptoms, there are effective treatments available for both conditions.

While these conditions share some commonalities, Cushing’s syndrome and Addison’s disease are two distinct medical issues that require close attention from a healthcare professional.

Key Differences: Addison Disease vs. Cushing Syndrome

Keep in mind, Addison’s disease and Cushing’s syndrome have some distinct differences:

• Addison’s disease can occur when the adrenal glands don’t produce enough hormones, while Cushing’s syndrome is typically caused by excess hormone production in the adrenal glands.[1,5]
• While surgical treatments for Cushing’s syndrome are available, surgeries generally aren’t used to treat Addison’s disease. Instead, people living with the latter often take hormone replacement medications.[4]
• Many Cushing’s syndrome cases are caused by long-term use of specific prescription medications. While there are some medications that can reduce adrenal function, Addison’s disease is typically endogenous instead of exogenous.
• Cushing's syndrome can present with clear, visual symptoms: stretch marks, abnormal body fat patterns, and a hump between your shoulders, for instance. The symptoms of Addison’s disease can be more difficult to spot on the outside—patients might feel their symptoms instead of seeing physical changes.

Which Treatment Options May be Right For You?

If you suspect that you’re experiencing abnormal adrenal function (either excessive hormone production or low hormone levels), working with a medical expert is key. A healthcare provider can help you confirm your diagnosis and find a treatment plan that works best for your wellness goals and lifestyle.

While it’s difficult to say which Addison’s disease or Cushing’s syndrome treatments may be right for you, qualified healthcare experts have the knowledge and experience to support your adrenal journey.

Learn More About Your Health With Everlywell

Addison disease vs. Cushing syndrome: while both are adrenal, they can have vastly different impacts on your long-term health and wellness.

If you’re looking to set healthcare goals, learn more about your body, and find compassionate, expert providers, turn to Everlywell. We offer digital healthcare at your fingertips—from at-home testing to women’s online health services and more.

Learn more about our mission to bring you the high-quality care you deserve.

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Cushing Syndrome Diet: What to Know

References

1. Adrenal glands. MedlinePlus. April 29, 2022. URL. Accessed November 12, 2023.
2. Definition & Facts of adrenal insufficiency & Addison’s disease. National Institute of Diabetes and Digestive and Kidney Diseases. September 2018. URL. Accessed November 12, 2023.
3. Symptoms & causes of adrenal insufficiency & Addison’s disease. National Institute of Diabetes and Digestive and Kidney Diseases. September 2018. URL. Accessed November 12, 2023.
4. Treatment for adrenal insufficiency & Addison’s disease. National Institute of Diabetes and Digestive and Kidney Diseases. September 2018. URL. Accessed November 12, 2023.
5. Cushing’s syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. May 2018. URL. Accessed November 12, 2023.
6. Diagnosis of adrenal insufficiency & Addison’s disease. National Institute of Diabetes and Digestive and Kidney Diseases. September 2018. URL. Accessed November 12, 2023.

Jillian Foglesong Stabile, MD, FAAFP is a board-certified Family Physician. Since completing her residency training in 2010, she’s been practicing full-scope family medicine in a rural setting. Dr. Foglesong Stabile’s practice includes caring for patients of all ages for preventative care as well as chronic disease management. She also provides prenatal care and delivers babies. Dr. Foglesong Stabile completed a teaching fellowship in 2020 and teaches the family medicine clerkship for one of her local medical schools. Dr. Foglesong Stabile’s favorite thing about family medicine is the variety of patients she sees in her clinical practice.