Addison’s disease is an endocrine or hormonal ailment that affects men and women of all ages and genders equally. The disease is marked by weight loss, muscle weakness, weariness, low blood pressure, and sometimes skin discoloration on both exposed and non-exposed body areas.
Why does it occur?
Typically, a problem with the immune system causes the immune system to attack the outer layer of the adrenal gland (the adrenal cortex), so interfering with the production of the steroid hormones aldosterone and cortisol. It is unknown why this occurs, although it accounts for 70-90 percent of occurrences in the UK.
Additional potential causes of Addison’s disease include tuberculosis, trauma with adrenal gland bleeding, surgery, fungal infections, inflammation, and malignancy. Genetic abnormalities may potentially cause Addison’s disease.
Types
Primary adrenal insufficiency
This syndrome is caused by direct adrenal cortex damage. This is the adrenal glands’ outermost layer.
Causes include:
- An autoimmune illness
- Diseases such as tuberculosis, CMV, and HIV
- Adrenal gland bleeding caused by trauma, blood clots, or other factors
- Diseases including hemochromatosis, malignancy, and amyloidosis
- Congenital conditions, including congenital adrenal hyperplasia
- The use of drugs that inhibit cortisol production, such as ketoconazole and etomidate
Secondary adrenal insufficiency
Indirectly, pituitary gland disorders can cause Addison’s disease. The pituitary gland generates adrenocorticotropic hormone (ACTH), which encourages the adrenal glands to generate more hormones.
When pituitary glands are affected, they may produce less ACTH. As a consequence, the adrenal glands will produce fewer hormones.
Other secondary adrenal insufficiency causes include:
- Tumors of the pituitary gland or inflammation
- Surgical excision of the pituitary gland
- Hemorrhage within the pituitary gland
- inherited disorders affecting the pituitary gland
The use of steroid medicines that affect the brain and the pituitary gland and inhibit the body from making ACTH can also lead to secondary adrenal insufficiency. This results in a decrease in glucocorticoid, a type of steroid. Typically, withdrawal symptoms emerge after a person ceases using drugs, especially if they do so abruptly.
Symptoms
Due to the fact that the symptoms of Addison’s disease are not distinct or dissimilar to those of many other medical disorders, the disease can be difficult to diagnose initially. In the early stages, patients frequently experience the following symptoms:
- Fatigue
- A heightened desire for salty foods
- Enhanced thirst
- Aggression or depression
- Muscular ache
- Unplanned weight loss
- Frequent urination
If left untreated, the aforementioned symptoms might increase progressively over the course of months or years, particularly in the presence of considerable emotional stress or the development of other disorders. When this occurs, patients may exhibit the following symptoms:
- Abdominal pain
- Chronic weariness
- Confusion
- Diarrhea
- Trouble concentrating
- Fainting
- Hyperpigmentation or skin discoloration
- Menstrual irregularities in women
- Aching joints or back
- Low blood sugar/blood pressure
- Muscle cramping
- Decreased sexual desire
- Acute anxiety
- Ulcers of the mouth
- Vomiting
Patients with Addison’s disease are susceptible to Addisonian crisis if they become excessively dehydrated, contract a serious illness, or sustain an injury that induces physical shock. If patients receiving therapy for adrenal insufficiency do not take their prescribed drugs, the condition also develops. Among its symptoms are:
- High amounts of potassium
- Consciousness loss
- Low arterial pressure
- Low sodium content
- Pain in the lower extremities, abdomen, or back
- Gastrointestinal issues, such as severe diarrhea and vomiting, which may result in dehydration
- Untreated Addisonian crises can result in shock, convulsions, and death.
Adrenal Crisis
Adrenal crisis, also known as an Addisonian crisis, occurs when cortisol levels drop so precipitously that it causes severe and sometimes life-threatening symptoms, such as:
- Extreme vomiting and/or diarrhea that causes dehydration
- Lower back, leg, or abdominal pain
- Shivering (syncope)
- Muscle spasms
- Confusion and disorientation
- Extreme parchedness and incapacity to urinate
- Abnormal cardiac rhythms (arrhythmia)
- Intermittent paralysis of the muscle
In the absence of vigorous treatment with intravenous fluids and steroids, hypotensive shock and respiratory failure are the most common causes of mortality. According to a study, one out of every sixteen adrenal crises leads to death, most often due to delayed or poor treatment.
Addison's disease diagnosis
Tests:
- Electrolyte levels
- Blood cortisol
- Plasma adrenocorticotropic hormone (ACTH)
- Occasionally ACTH stimulation tests
Clinical signs and symptoms indicate adrenal insufficiency. Occasionally, the diagnosis is only considered upon the identification of serum electrolyte abnormalities, such as low sodium, high potassium, low bicarbonate, and high BUN (blood urea nitrogen).
Differential diagnosis
- Primary gastrointestinal disease (especially whipworm infection)
- Renal failure
- Acute pancreatitis
- Toxin consumption
For a definite diagnosis, the adrenal function must be evaluated. Once a baseline blood sample has been obtained, ACTH (gel or synthetic) is delivered. Gel preparations are delivered intramuscularly, and two hours later, a second blood sample is taken. Synthetic preparations are supplied intramuscularly or intravenously, followed by second blood draw one hour later. Cortisol concentrations >2.0 mcg/dL during repose effectively eliminate the diagnosis of hypoadrenocorticism, whereas levels of 2.0 mcg/dL necessitate ACTH stimulation testing to confirm the diagnosis. In both classic and atypical cases, affected dogs have low baseline cortisol levels, and there is little response to ACTH delivery. This test can be performed on the majority of animals prior to beginning hormone replacement medication.
Treatment
The goal of treatment is to restore the hormone levels that your body is not making. Regardless of whether you have primary or secondary adrenal insufficiency, you will always require hormone replacement.
Oral hydrocortisone pills are administered once or twice daily to replace cortisol. If you are also weak in aldosterone, it is substituted by once-daily dosages of fludrocortisone acetate, a mineralocorticoid.
As replacement demands for adrenal hormones differ among individuals, treatment must be individualized.
How to use injectable hydrocortisone if you are vomiting and unable to keep down oral meds.
They will also advise you on how to communicate your needs to emergency medical staff. This may consist of:
- Displaying a medical alert bracelet or necklace
- Carrying a card informing emergency personnel:
- That you require a cortisol injection if you are severely hurt or unable to respond to questions.
- The name and telephone number of your physician
- Who to contact in the event of an emergency.
What foods should I consume if I suffer from adrenal insufficiency?
Some Addison’s disease patients with low aldosterone may benefit from a high-sodium diet. A health care expert or nutritionist can propose the best sources of sodium and the recommended daily sodium intake.
Corticosteroids at high doses are associated with an increased risk of osteoporosis, a condition in which the bones become less thick and more prone to fracture. If you use corticosteroids, you may need to consume sufficient calcium and vitamin D to protect your bone health. A dietician or health care expert can tell you how much calcium you should consume based on your age. Additionally, you may need to take calcium supplements.
Prognosis
Addison’s illness requires treatment for a lifetime. Treatments, such as hormone replacement drugs, can assist with symptom management.
Important step toward living a productive life is following the treatment plan prescribed by your doctor.
Always take your medications precisely as prescribed. Too little or too much medication might be harmful to your health.
Your treatment plan may require reevaluation and modification based on your situation. Therefore, it is essential that you consult your doctor regularly.
