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Research led by University of Birmingham scientists has found that people suffering from the adrenal disorder known as Addison's disease suffer from an immune system defect which makes them prone to potentially deadly respiratory infections. The study, published online in the European Journal of Endocrinology, shows for the first time that patients with primary adrenal insufficiency (PAI) have natural killer immune cells (NK) - providing frontline protection against invading pathogens - which are not functioning properly. It concludes that this might explain why Addison's patients are prone to respiratory infections which have been shown previously to contribute to an increased risk of premature death in affected patients. Patients with adrenal insufficiency have also been reported to suffer from an increased rate of non-fatal infections, with a 1.5-fold increased risk of use of anti-microbial agents and a 4.0- to 5.0-fold increased risk of hospital admission for infection, with rates of pneumonia reported to be more than nine times higher in adrenal insufficiency patients. However, despite well-documented reports about increased incidence and severity of infection among PAI patients, it was not known why they succumb more readily to infections than the general population. Daily corticosteroid replacement therapy is the standard treatment for adrenal failure, and since its introduction, life expectancy of PAI patients has increased considerably. But despite ready availability of corticosteroid replacement, Addison's patients not only suffer from a poorer quality of life but from an increased risk of premature death.