Addison's Disease

Addison's Disease

Addison's disease is something that can strike anyone at any age and affects the person's Adrenal Glands. This disease, which is often referred to as hypocortisolism or chronic adrenal insufficiency, happens when a person's adrenal glands are not able to product enough hormones. What happens is that there is an insufficient amount of cortisol and sometimes aldosterone. Addison's disease can prove to be life threatening.

Addison's Disease Symptoms



Addison's disease can affect people in different ways when it comes to symptoms. The individual may suffer from just one or a whole host of different symptoms. It's also important to note that these symptoms don't usually just suddenly appear; instead, they build slowly over time. Here's a look at some of the most common symptoms that go hand-in-hand with the disease.

• Depression


• A craving for salty foods and salt


• A decrease in the appetite, Weight Loss


• Diarrhea, nausea, and/or vomiting


• General fatigue and muscle weakness


• Low Blood Pressure that can result in the person fainting


• Hyperpigmentation (skin that gets darker)


• Irritability


• Hypoglycemia (low blood sugar)


• Joint and muscle pains


• Loss of body hair


• Sexual dysfunction (in women)

Addisonian Crisis Symptoms

• Now if the person is suffering from acute adrenal failure, which is called an Addisonian crisis, the symptoms are quick to appear. These symptoms can include:


• Low blood pressure


• Hyperkalemia (high potassium levels)


• A loss of consciousness


• Pain in the legs, abdomen, and/or lower back


• Severe cases of diarrhea and vomiting, this can result in Dehydration

When to See a Doctor
It's important to visit the doctor if you develop or suddenly have any of the above mentioned symptoms whether it is just one of the symptoms, or a combination of them. Your doctor will be able to figure out if Addison's disease is the cause so that a proper treatment method can be laid out.

Why It Happens
There are actually two different types of the disease. If the person has primary adrenal insufficiency, it means the issue is the adrenal glands. Meanwhile if they are diagnosed with secondary adrenal insufficiency, it means the issue is that the adrenal glands are underperforming due to a problem elsewhere in the body. This can mean there is a problem with the person's pituitary gland.

Primary Adrenal Insufficiency Causes
In the case of primary adrenal insufficiency the cause is most often autoimmune disease. In fact, this is the case in 70% of the cases of Addison's disease. In these cases the body begins to fight the adrenal glands due to an immune system mistake. What ends up happening is that the outer area of the glands is completely ruined. Apart from autoimmune disease, there are other illnesses that can cause primary adrenal insufficiency, which include Hiv, Tuberculosis, some fungal infections as well as Cancer cells spread to adrenal glands.

Secondary Adrenal Insufficiency Causes
The causes of secondary adrenal insufficiency are typically a problem with the Hypothalamus or the pituitary gland. These are both found in the center of the brain and each is responsible for controlling the production of hormones.Over-usage of steroid hormones such as prednisone can also cause this condition. In rare cases, pituitary gland damage from radiation or surgery and pituitary gland Tumors may be the causes.

Diagnosing Addison's Disease
Diagnosis is an important step and can be done by speaking with your doctor. To begin with, your medical history will be discussed. There are also a variety of tests that can be performed. Here's a look at them.

• Imaging Tests - A doctor may request for an MRI scan or a CT scan. The MRI scan will be taking a look at your pituitary gland, whereas the CY scan will look at the size of your adrenal glands, your abdomen, and other areas.


• ACTH Stimulation Test - In this test the person will be given a shot of ACTH, a synthetic form of it. The person's cortisol level will be taken both before and after the shot to see what your adrenal gland does after ACTH is sent into the body.


• Blood Test - A blood test may be performed to take a look at your cortisol, potassium, and sodium levels.


• Insulin-Induced Hypoglycemia Test - Although not as common, this test may be recommended by the doctor. It will test for secondary adrenal insufficiency due to pituitary disease. The test focuses on your cortisol and blood sugar levels.

How Can It Be Treated?
Treatment is a key part of Addison's disease, especially since the disease can be life-threatening. Treatment usually is determined by the actual cause of the disease, as there are different routes to take.

• Medications: Typically a person won't have to remain in the hospital in order to receive care; instead they will be put on medication they can take at home. As well they will need to perform check-ups on a regular basis to be sure the medication is doing its job.The drugs that are usually prescribed are glucocorticoids. These will need to be taken forever in order to be effective.


• Hormone replacement therapy is sometimes used. This type of therapy can prove to be quite beneficial as long as the person follows the doctor's orders on dosage information.


• For Addisonian crisis patients, then they usually need to be admitted into the hospital immediately. Doctors will then proceed with sugar and fluid replacement as well as hydrocortisone injections.

Warning
The key with the medications is that you take exactly the amount prescribed at the intervals that have been given to you. If the person veers off-course with their treatment, there can be some rather serious health side effects.

It's also recommended to carry with you extra medication at all times, just in case. You can wear a medical alert bracelet or carry a card, and you can even carry with you an injectable corticosteroid, which is key in an emergency situation.

Addison's Disease

Addison's Disease

A rare hormonal or endocrine disorder which affects around 1 in 100,000 people, Addison’s disease happens in any age group and afflicts women and men equally. Symptoms from this disease include muscle weakness, Weight Loss, low Blood Pressure, fatigue and occasionally darkening of the skin in both non-exposed and exposed parts of the body.

Cortisol and Addison’s Disease
When the Adrenal Glands don’t make enough of the hormone cortisol and in some cases, aldosterone as well, Addison’s disease occurs. These low cortisol levels are the reason the disease is sometimes known as chronic adrenal insufficiency, or hypocrotiosolism.

Normally made by the adrenal glands which are found right above the kidneys, cortisol belongs to a class of hormones known as glucocorticoids. These affect just about every tissue and organ in the body. The most important job of cortisol is to assist the body in response to Stress. Besides its other vital tasks, cortisol:

• Helps to slow the inflammatory response of the immune system


• Helps keep up cardiovascular function and blood pressure


• Helps balance the effects of insulin when breaking down sugar for energy


• Helps to regulate the metabolism of carbohydrates, proteins and fats

Since cortisol is so detrimental to health, the amount of cortisol made by the adrenal glands is balanced exactly. The failure to make the right levels of cortisol can happen for various reasons. The problem could be the result of a disorder of the adrenal glands, or primary adrenal insufficiency, or because of inadequate secretion of ACTH by the pituitary gland, or secondary adrenal insufficiency.

Symptoms of Addison’s Disease
Symptoms of Addison’s disease generally develop slowly, many times over several months and could include:

• Decreased appetite and weight loss


• Fatigue and muscle weakness


• Hyperpigmentation, or darkening of the skin


• Low blood pressure, and sometimes fainting


• Love blood sugar or hypoglycemia


• Craving for salt


• Irritability


• Joint or muscle pains


• Vomiting, nausea or Diarrhea


• Depression


• Loss of body hair or sexual dysfunction for women

Acute Adrenal Failure or Addisonian Crisis
There are instances, however, where the symptoms and signs of the disease can appear quickly. In this situation, the symptoms sand signs can also include:

• Severe diarrhea and vomiting which leads to Dehydration


• Pain in abdomen, legs or lower back


• Loss of consciousness


• High potassium or hyperkalemia

When to Visit Your Doctor
Visit your doctor if you have symptoms and signs which happen commonly in people with Addison’s disease like:

• Severe fatigue


• Hyperpigmentation


• Unintentional weight loss


• Fainting or dizziness


• Cravings for salt


• Gastrointestinal problems like vomiting, abdominal pain and nausea


• Joint or muscle pains

Your doctor will be able to figure out if you have Addison’s disease or another medical condition.

Causes & Risk Factors of Addison’s Disease
Small organs found near the top of each kidney that release hormones are known as the adrenal glands. They are comprised of an inner portion known as the medulla and the outer portion known as the cortex.

The cortex makes three types of hormones:

• Mineralocorticoid hormones like aldosterone, regulate potassium and sodium balance


• Glucocorticoid hormones like cortisol keep up sugar or glucose control and lower the immune response, plus help the body react to stress


• Sex hormones (androgens for males and estrogen for females) affect sex drive and sexual development

If the adrenal cortex is damaged, it can cause Addison’s disease. This damage makes the cortex produce hormone levels which are too low, causing low cortisol symptoms.

This type of damage can be caused by:

• Infections like Tuberculosis, fungal infections or Hiv


• The immune system will make the mistake of attacking the adrenal glands


• Tumors


• A hemorrhage inside the adrenal glands

Risk factors of other autoimmune diseases include:

• Dermatitis herpetiformis


• Chronic Thyroiditis


• Hyperparathyroidism


• Grave’s disease


• MyAsthenia gravis


• Hypopituitarism


• Testicular dysfunction


• Pernicious anemia


• Vitiligo


• Type 1 Diabetes

Adrenal insufficiency could also be caused by certain rare genetic defects.

Diagnosis of Addison’s Disease
Your doctor will ask you about your health to diagnose Addison’s disease, such as if you’ve had Cancer or if you have HIV or any history in your family of Addison’s disease. You will also go through a physical exam so your doctor can check for changes in the color of your skin, check blood pressure and look for dehydration signs.

Your doctor could also order tests:

• ACTH stimulation test – this checks how your hormone levels react to stress.


• Blood tests check for low sodium levels or high potassium. Your ACTH and cortisol levels might be checked as well.


• Imaging tests like an MRI, orCT scan to look for any damage to the adrenal glands.

Treatments for Addison’s Disease
All treatments will involve hormone replacement therapy so that the levels of steroid hormones that aren’t being produced can be fixed. Some options include:

• Corticosteroid injections. If you are ill and vomiting and you can’t keep oral injections down, this is a good alternative.


• Oral corticosteroids. You could be prescribed fludrocortisone to replace aldosteroine. Prednisone, hydrocortisone or cortisone acetate could be used to replace cortisol.


• Androgen replacement therapy. For androgen deficiency in women, you could be prescribed dehydroepiandrosterone. Studies have suggested that this could improve your overall sense of well-being, sexual satisfaction and libido.

A good amount of sodium is recommended, especially when the weather is hot, during a lot of exercise or if you have gastrointestinal problems. Your doctors could also temporarily increase you dosage if you are facing a stressful situation like an infection, operation or minor illness.

Surgery & Injections
People who have chronic adrenal insufficiency that need surgery with general anesthesia are treated with injections of saline and hydrocortisone. Injections start on the evening prior to surgery and keep going until the patient is completely awake and able to take oral medication. The dosage will be adjusted until the maintenance dosage given prior to surgery is achieved.

Pregnancy
Women who have primary adrenal insufficiency and get pregnant are treated with standard replacement therapy. If vomiting and nausea in the earlier stages of pregnancy interfere with oral medication, injections of the hormone could be needed. Treatment during delivery is similar to patients who need surgery. Following delivery, the dosage is slowly tapered.And the regular doses of fludrocortisone acetate and hydrocortisone orally are reached by around ten days after birth.

Addisons Disease

Addisons Disease






When the adrenal glands of the body do not produce sufficient amount of hormone called cortisol/aldosterone it causes Addison’s disease. This manifests in the form of loss of weight, muscular weakness, tiredness and low Blood Pressure. This disease is otherwise known as hypocortisolism. It can occur in both sexes and on any individual. The symptoms can be fully controlled by effective replacement of hormone therapy.

Symptoms :

Addison’s disease progresses slowly and for some people it may take months or even years to show its symptoms. Some of the signs of this disease include skin darkening, Weight Loss, loss of appetite, fatigue, low blood sugar and low blood pressure. Some people may even faint suddenly due to reduced blood pressure. It can also cause irritability, nausea, joint pain and Depression. In women there can be loss of body hair and sexual dysfunction due to suppression of hormone.

In rare cases, the symptoms would appear suddenly causing severe vomiting, abdominal pain and loss of consciousness. It would also reduce the salt content in the body and this condition is called acute adrenal failure. If you have fatigue, nausea, vomiting, dizziness and craving for salt then you need to consult doctor immediately.

Causes :

Addison’s disease is caused by improper functioning of adrenal glands. These glands are found above your kidneys and are responsible for producing aldosterone and cortisol hormone. This gland is part of endocrine system and controls every organ and tissues in your body.

Corticosteroids are secreted by the outer layer of the gland called cortex and adrenaline hormone is secreted by interior layer called medulla. The cortex region also produces gluco-corticoids (responsible for converting the food substances into energy), mineralocorticoids (aldosterone which controls the sodium and potassium levels in your body thus maintaining the blood pressure) and androgens (male sex hormone). Androgen hormone is responsible for sex drive and builds up muscle mass in the body for both men and women.

Any imbalance in the production of these hormones will have serious effect on the immune system. Addison’s disease is a kind of autoimmune disorder which means the body’s own immune system will attack and destroy healthy cells/tissues of the cortex. Primary adrenal insufficiency and secondary adrenal insufficiency can also cause this problem. When the pituitary gland is tampered (due to some reason) it may not produce enough amounts of ACTH (adrenocorticotropic hormone) which in turn slows down the production of adrenal hormone causing Addison’s disease. This process is termed as secondary adrenal insufficiency.

Addison’s disease occurs rarely (1 out of million) and very often this disease is caused due to autoimmune disorder. Polyendocrine deficiency syndrome can also cause failure of adrenal gland called Type 1 problem which is seen in children due to underactive thyroid glands, anemia and chronic hepatitis. Type 2 problem occurs in young adults leading to diabetes, slow sexual development, loss of pigment on the skin. In rare cases Tuberculosis can also attack the adrenal glands causing Addison’s disease. Patients who are taking corticosteroids for long time can get this problem when they stop taking the drug suddenly.

Role of Cortisol and Aldosterone :

Cortisol hormone is classified under the category of glucocorticoids. It assists in maintaining the blood pressure of the body, and helps in balancing the insulin level and regulates the protein and carbohydrate metabolism. Aldosterone helps in maintaining blood pressure and regulates the salt and water content in the body. Any discrepancy in its level will cause imbalance in potassium and sodium level causing renal failure.

Diagnoses :

Your doctor will collect complete medical history and order for blood test for checking the levels of sodium and potassium. The same blood profile will also give information about the count of antibodies related to immune system. He may request for ACTH stimulation test and CRH stimulation test for checking the level of cortisol in blood. In rare cases he may conduct insulin induced hypoglycemia test if he suspects secondary adrenal insufficiency. If needed, he may conduct CT scan of the abdomen to rule out any abnormalities.

Treatment :

Any method of treatment given is to regularize the level of hormone in the body. Depending on the health condition of the patient, he may prescribe oral corticosteroids like fludrocortisones or Cortef. For some cases, he may inject corticosteroid directly if the patient does not tolerate oral drugs. Androgen replacement therapy is recommended for treating its deficiency. Drugs like dehydropiandrosterone are given for women with androgen deficiency for inducing libido and increasing sense of well-being.

To compensate loss of sodium and potassium ions in blood sufficient amounts are given orally. The dosage of sodium is required more than regular dose while doing heavy strenuous work and in stressful situations. For people with Addisonian crisis immediate medical care is to be given by injecting hydrocortisone intravenously. The patient will be put on IV fluids like saline solution or dextrose for compensating the blood sugar loss and to boost up blood pressure. In case of chronic problem surgery is to be done.

Coping Techniques :

In case your loved ones or relative have Addison’s disease it is suggested to carry a medical card so that others would render immediate help. Always ensure that you are keeping extra dose of medication with you in case you have lost it or missed one dosage. Taking corticosteroid injection with you will help you in case you feel like collapsing.

For pregnant women diagnosed with adrenal insufficiency instead of oral pills hormone injection would be the best option to control nausea/vomiting. After delivery, the dosage is reduced under close supervision and replaced by oral pills gradually.

Prevention :

It is not possible to prevent Addison’s disease, but you can take precautions to reduce stressful situations. You can always limit the risk factors of getting infections, watch your blood sugar level closely and identify any new symptoms.