What is Addison's Disease?

The adrenal gland in the body is responsible for producing two important hormones: cortisol and aldosterone. Addison's disease, also known as adrenal insufficiency occurs when the adrenal glands make too little cortisol and often too little aldosterone. Cortisol hormone is also known as stress hormone. This hormone is essential for life [1].

 

Addison's disease is a rare condition that is difficult to diagnose. Because of its insidious nature, the diagnosis is often delayed until the patient develops an acute adrenal crisis [2].

 

The untreated Addison's disease may progress to an Addisonian Crisis. Addisonian Crisis is a life-threatening situation that results in low blood pressure, hyperglycemia, and hyperkalemia. It is a medical emergency.

 

 

 

What are the Symptoms of Addison's Disease?

 

Addison's disease is a rare condition, characterized by the following signs and symptoms [3]:

• Weakness
• Fatigue
• Poor appetite
• Weight loss
• Vitiligo
• Hyperpigmentation
• Vomiting
• Nausea
• Diarrhea
• Dizziness
• Myalgias
• Flaccid Muscle Paralysis
• Low blood sugar level
• Low blood pressure
• Depression
• Hair loss
• Arthritis
• Salt Cravings
• Heightened sense of smell, taste and hearing
• Decreased libido in male patients
• History of amenorrhea in female patients

 

The presentation of acute Addison's disease can include the following:

• Prominent Nausea
• Vomiting
• Vascular collapse
• Pain in lower back or legs
• Hyperpyrexia with the temperature reaching 105°F or higher. The patient may be comatose
• Abdominal symptoms
• The patient may be in shock, and appear hypnotic and confused

 

 

 

What are the Causes of Addison's Disease?

 

Addison's disease is caused by the damage to the adrenal glands. Adrenal glands are located just above the kidney. They produce important hormones that influence all organs of the body. [4]

 

The adrenal gland is made up of two sections: the outer layer known as the cortex, and the inner layer known as the medulla.

 

Primary adrenal insufficiency occurs when the adrenal cortex is damaged. As a result, the body is unable to make corticosteroid hormones.

 

The causes of primary adrenal insufficiency are autoimmune disease, tuberculosis, bleeding into adrenal glands, the spread of cancer to the adrenal glands, and other infections.

 

Secondary adrenal insufficiency occurs due to causes unrelated to the adrenal glands such as pituitary tumors, inflammation, and surgery.

 

In secondary adrenal insufficiency, the body makes little androgens and glucocorticoids because of too little Adrenocorticotropic hormone (ACTH) by the pituitary.

 

 

 

What are the Treatment options for Addison's Disease?

 

The suggested treatment of Addison's disease is Hormone replacement therapy.

• Hydrocortisone
• Prednisone
• Methylprednisolone

 

These hormones are given to replace cortisol:

 

• Fludrocortisone acetate to replace aldosterone
• Salt is recommended especially in hot weather and upset stomach.

 

Some management recommendations include:

• Carry a medical alert and bracelet at all times
• Keep extra medicine handy
• Carry a glucocorticoid injection kit
• Have yearly checkups

 

 

 

References:

1. https://www.webmd.com/a-to-z-guides/understanding-addisons-disease-basics
2. https://www.ncbi.nlm.nih.gov/books/NBK441994/
3. https://emedicine.medscape.com/article/116467-overview
4. https://www.mayoclinic.org/diseases-conditions/addisons-disease/symptoms-causes/syc-20350293#:~:text=Addison's%20disease%2C%20also%20called%20adrenal,little%20of%20another%20hormone%2C%20aldosterone.
5. https://www.mayoclinic.org/diseases-conditions/addisons-disease/diagnosis-treatment/drc-20350296

 

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