Job Accommodation Network

Addison's disease is a rare endocrine, or hormonal disorder that affects about 1 in 100,000 people. It occurs in all age groups and affects men and women equally. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and sometimes darkening of the skin in both exposed and nonexposed parts of the body. Addison's is a severe or total deficiency of the hormones made in the adrenal cortex, caused by a destruction of the adrenal cortex. There are normally two adrenal glands, located above each kidney. The adrenal glands are really two endocrine, ductless or hormone producing, glands in one. The inner part of the adrenal, called the medulla, produces epinephrine also called adrenaline, which is produced at times of stress and helps the body respond to "fight or flight" situations by raising the pulse rate, adjusting blood flow, and raising blood sugar. However, the absence of the adrenal medulla and epinephrine does not cause disease. In contrast, the outer portion of the adrenal, the cortex, is more critical. The adrenal cortex makes two important steroid hormones, cortisol and aldosterone. Cortisol mobilizes nutrients, modifies the body's response to inflammation, stimulates the liver to raise the blood sugar, and also helps to control the amount of water in the body. Aldosterone regulates salt and water levels which affects blood volume and blood pressure. Cortisol production is regulated by another hormone, adrenocorticotrophic hormone (ACTH), made in the pituitary gland which is located just below the brain. Classical Addison's Disease results from a loss of both cortisol and aldosterone secretion due to the near total or total destruction of both adrenal glands. This condition is also called primary adrenal insufficiency. If ACTH is deficient, there will not be enough cortisol produced, although aldosterone may remain adequate. This is secondary adrenal insufficiency, which is distinctly different, but similar to Addison's Disease, since both include a loss of cortisol secretion. From http://www.medhelp.org/nadf/nadf3.htm.

Accommodation ideas for individuals with Addison's Disease may include:

Managing Fatigue: An individual with Addison's Disease may benefit from a flexible work schedule, liberal use of leave time, being allowed to work from home, a reduction or elimination of physical exertion and workplace stress, scheduled rest breaks away from the workstation, and ergonomic workstation design.

Controlling Weight: Because of salt loss, a craving for salty foods is common. Easy access to snacks and a refrigerator may help.

Working in a Cold Environment: Specially designed clothing, individual space heaters, and controlled thermostats can reduce the effects of working in a cold environment. Allowing work from home during extremely hot or cold weather, maintenance of the ventilation system, and redirecting air conditioning and heating vents may also help.

Difficulty Standing and Walking due to Blood Pressure Loss: A wheelchair or scooter may accommodate these limitations when moving around a workplace. Stand/lean stools and adjustable workstations also help individuals convert standing areas to sitting workstations.

Low Vision: An individual with a Addison's may have low vision. For information on accommodations for individuals with vision impairments, visit SOAR's Accommodations for Vision Impairments or JAN's general publication on Work-site Accommodation Ideas for Individuals with Vision Impairments.

Managing Depression: Developing workplace strategies to deal with work problems before they arise, providing sensitivity training to coworkers, allowing telephone calls during work hours to doctors and others for support, and easy access to information on counseling and employee assistance programs are beneficial.

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