Salt cravings and hormones: when a craving for salty food needs checking

Most people enjoy salty food and many notice cravings at times without any underlying problem. The pages used for this guide focus on the hormonal cause that doctors are most concerned not to miss, Addison's disease, and do not list other reasons for salt cravings, so this page does not attempt a full list of causes. What matters in practice is whether the craving is new, strong and persistent, and whether it comes with other symptoms.

A craving on its own is rarely an emergency. A craving together with unexplained fatigue, weight loss, dizziness on standing or darker skin is a reason to ask a GP for an assessment, because the NHS and NHS inform both stress that the symptoms of Addison's disease overlap with those of many other conditions and that they are easy to miss.

NHS inform explains that the adrenal glands are two small glands on top of the kidneys that produce the essential hormones cortisol, aldosterone and adrenaline. In Addison's disease the adrenal gland is damaged, and not enough cortisol and aldosterone are produced. NHS inform says dehydration can be an early sign and that it is caused by a lack of aldosterone, which is used to regulate the balance of salt and water.

The Addison's Disease Self-Help Group describes aldosterone as acting on the kidneys to tell them to keep salt in the body. Without it, the kidneys are constantly leaking sodium, leading to light-headedness, postural dizziness, low blood pressure, a washed-out or weak feeling, cramps and spasms, and abdominal or lower back pain. As well as these symptoms, many people start to crave salty foods such as crisps, pickles, olives and soy sauce, as well as vinegar, lemons and sour sweets.

The NHS lists the symptoms of Addison's disease, noting that many are the same as those of other conditions.

• Extreme tiredness and areas of skin that are darker than the surrounding skin, which may be harder to see on brown or black skin.

• Loss of appetite, weight loss, tummy pain, feeling or being sick and cravings for salty foods.

• Feeling dizzy or light-headed when standing up.

• Joint pain, muscle weakness and muscle cramps.

• Headache, a slightly raised temperature, thirst and needing to pee a lot.

• Difficulty concentrating, anxiety and depression.

The NHS advises seeing a GP if you think you might have Addison's disease. A GP who suspects it will refer you to a specialist, usually an endocrinologist, or a paediatrician for a child.

An adrenal crisis is the most serious complication, and the NHS says it can be triggered by things like an infection, an accident or surgery. If you already have Addison's disease and symptoms suddenly get worse, or you have a fast heart rate, feel very dizzy, have severe tummy pain, muscle weakness, a headache that does not go away, sickness, drowsiness, confusion, a seizure or loss of consciousness, call 999, even if you have given yourself an emergency steroid injection. NHS inform lists severe nausea, confusion, fever, headache and weakness among the warning signs.

The NHS says a specialist will ask about your symptoms and you may have a test to see how well your adrenal glands are working, in which blood samples are checked before and after an injection of a medicine called Synacthen, and blood tests to check hormone levels and thyroid function. Tests need to be interpreted by an endocrinologist, so avoid adjusting salt intake or medicines in the meantime without medical advice.

NHS inform says that in the UK the most common cause is a problem with the immune system, accounting for 70% to 90% of cases. Other causes include infections such as tuberculosis, though that is uncommon in the UK, and surgery to remove the adrenal glands, according to the NHS.

The main treatment is steroid replacement. The NHS lists hydrocortisone, prednisolone and fludrocortisone as medicines that may be given, usually taken every day for life, with extra medicine at times such as illness or surgery, and a steroid emergency card to carry. With treatment you can have a good quality of life with a normal life expectancy, according to the NHS.

The Addison's Disease Self-Help Group says that normal dietary advice to avoid too much salt does not apply to people with primary adrenal insufficiency, and that a craving for salty or sour food is a message from the body to take something salty. It explains that fludrocortisone compensates for lack of aldosterone, that hot weather or vigorous exercise increases salt loss, and that doses should only be changed after speaking to an endocrinologist. It also advises using real table salt rather than low-sodium products, avoiding liquorice, and watching for puffy ankles as a possible sign of too much salt or fludrocortisone. This advice is for people who have been diagnosed and are under specialist care, not for self-treatment.

Diagnosis and long-term care on the NHS are usually led by an endocrinologist after a GP referral, with your care team passing information to the rare disease registration service unless you opt out. Private endocrinology can speed up the first assessment and testing. Whichever route, treatment is lifelong, and having a steroid card, an emergency injection kit and a clear plan for illness is as important as the daily tablets.