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ADDISON’S DISEASE

Men's Health, Mental Health, Women's Health / By

ADDISON’S DISEASE

Addison’s disease is a rare endocrine disorder that occurs when the adrenal gland is unable to produce enough of the hormone cortisol and in some cases the hormone aldosterone.

  • The adrenal glands are small glands located on top of each kidney and are responsible for making different hormones including the steroid hormone cortisol and aldosterone.
  • While cortisol belongs to a class of hormone called glucocorticoids and helps the body respond to stressful situations including stress of illness, injury, or surgery, aldosterone belongs to a class of hormone called mineralocorticoids and helps to maintain blood pressure and water and salt balance in the body by helping the kidney with sodium retention and potassium excretion.
  • When the adrenal gland produces insufficient aldosterone, the kidneys are not able to regulate salt and water balance, affecting blood volume and blood pressure.
  • The condition also called adrenal insufficiency occurs in both men and women equally and in all age groups
  • Addison’s disease can be life-threatening.

CAUSES

Two major classifications exist for Addison’s disease: primary adrenal insufficiency and secondary adrenal insufficiency.

Primary adrenal insufficiency is caused by severe damage to the cortex (the outer layer of the adrenal gland) that they can no longer produce enough hormones. This commonly results from an attack on the adrenal gland by the body’s immune system. This is called an autoimmune disease. In an autoimmune disease, the body’s immune system mistakes organs in the body – in this case, the adrenal gland, as a virus, bacteria, or a foreign invader and produce antibodies to attack and destroy it. About 70% of reported cases of Addison’s disease are due to an autoimmune disorder.

Other causes of primary adrenal insufficiency include:

  • Tuberculosis
  • Cancer cells spreading from other parts of the body to the adrenal glands
  • Prolonged use of corticosteroids
  • Bleeding into the adrenal glands
  • Infections in the adrenal glands
  • Surgical removal of the adrenal glands

Secondary adrenal insufficiency is caused by a lack of adrenocorticotropic hormones (ACTH) made by the pituitary gland (located in the brain). ACTH tells the adrenal gland when to produce its hormone. A lack of ACTH causes a drop in the adrenal glands production of cortisol, but the aldosterone is not affected.

A temporary form of secondary adrenal insufficiency occurs when people who have been using glucocorticoids hormone (corticosteroid) such as prednisone for a long time to treat a certain inflammatory condition such as asthma, rheumatoid arthritis, or ulcerative colitis, stops abruptly or interrupts taking the medication at once rather than tapering it off. This happens because corticosteroid blocks the release of ACTH.

SYMPTOMS

  • Fatigue
  • Low blood sugar levels
  • Nausea, diarrhea or vomiting
  • Salt craving
  • Darkening of the skin
  • Weight loss or decreased appetite
  • Sores in the mouth
  • Low blood pressure
  • Muscle or joint pains
  • Depression
  • Irritability
  • Irregular menstrual period

Because the symptoms progress slowly, they may appear suddenly after a stressful event such as an accident or illness makes them worse. This is called acute adrenal insufficiency or Addisonian crisis. In some cases, symptoms first appear during an Addisonian crisis.

Symptoms of Addisonian crisis may include:

  • Severe vomiting and diarrhea, followed by dehydration
  • Pain in the lower back, legs, or abdomen
  • Loss of consciousness
  • Low blood pressure

An Addisonian crisis may be fatal if left untreated

DIAGNOSIS AND TREATMENT

To make a diagnosis, the doctor will review your medical history and symptom. Dark patches on the skin might be a clue for the doctor to consider testing for Addison’s disease.

Other tests may include:

  • Blood tests to measure your blood levels of sodium, potassium, cortisol, and ACTH. A blood test can also measure antibodies associated with autoimmune Addison’s disease.
  • ACTH stimulation test to measure the level of cortisol in your blood before and after an injection of synthetic ACTH.
  • Insulin-induced hypoglycemia test to determine how the hypothalamus and pituitary gland and brain respond to stress. This is done if the doctor you may have secondary adrenal insufficiency.
  • Imaging tests such as CT scans of the abdomen to check the size of your adrenal glands and look for tumors, bleeding and other abnormalities. If secondary adrenal insufficiency is indicated after testing, MRI scan of the pituitary gland may be recommended.
TREATMENT

Treatment option includes hormone replacement therapy to substitute for the levels of steroid hormones that your body is not producing. Such as:

Hydrocortisone to replace cortisol, and fludrocortisone acetate to replace aldosterone.

Treatment for Addisonian crisis includes intravenous injection of hydrocortisone, salt water, and sugar.’.