Addison patient's have the adrenal cortex destroyed by the immune system or as is happening more recently in areas around the world by TB.  Most Addison adults try to get down to 20mg/day if possible and with out the androgen breakthrough to worry about generally have a lower dose.  The complication with addisons is that the immune system can go on and attack other glands like the thyroid and pituatary for example and treatment become much more difficult. It is interesting though that the cortex is the part wiped out and the medulla continues to be functional.

I seem to remember an endo linked to NIH doing research looking at the possibility of using adrenalecotomy in cases that were very difficult to control. As it was used in the past you would have thought it would be relatively easy to track down those patients and do a follow up study into their quality of life.

ShaunP.