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Addison’s Disease
Overview
On top of the kidney are pair of glands known as adrenal glands, below the diaphragm region. Adrenal glands are a type of endocrine glands that produce hormones known as adrenaline, cortisol, corticosterone, aldosterone, and male hormones which are collectively called androgens. Each of the adrenal glands is divided into two parts, both of which produce hormones. The two parts of each gland are called the outer adrenal cortex and inner medulla. A few different disorders of the adrenal gland are present that can include several tumors, congenital adrenal hyperplasia, Cushing’s disease, and Addison’s disease.
Addison’s disease is a type of disorder that involves adrenal glands. It is also known as ‘primary adrenocortical insufficiency’. In this glands are damaged and they are not able to produce enough cortisol. Sometimes, adrenal glands also produce small amounts of aldosterone. Production and regulation of hormones by adrenal glands is regulated by homeostasis. The production of hormones increases and decreases throughout the day depending on the surrounding environment. When the body is under stress, anterior pituitary produces the adrenocorticotrophic hormone that stimulates adrenal glands to produce more hormones. This is the reason why cortical is also known as ‘stress hormone’. Its function is to regulate metabolism and inflammatory response. It regulates blood sugar, electrolyte, and fluid in the body. The scarcity of cortisol affects all the important physiological processes and parameters by which the body is not capable of adapting to unfavorable conditions such as dehydration or abnormal glucose level.
Consulting Doctor
Endocrinologist.
Symptoms
Experiencing mental confusion.
-Feeling nauseous.
-Experiencing diarrhea.
-Irritable mood.
-Decreased hunger (loss of appetite).
-Abnormal thyroid function.
-Generalized weakness.
-Changes in skin pigmentation (hyperpigmentation).
-Unable to sleep.
-Experiencing chills.
-Experiencing vomiting.
-Decreased blood pressure.
Experiencing mental confusion.
-Feeling nauseous.
-Experiencing diarrhea.
-Irritable mood.
-Decreased hunger (loss of appetite).
-Abnormal thyroid function.
-Generalized weakness.
-Changes in skin pigmentation (hyperpigmentation).
-Unable to sleep.
-Experiencing chills.
-Experiencing vomiting.
-Decreased blood pressure.
-Low level of blood sugar.
-Feeling unconsciousness.
-Unexplained weight loss.
-State of being depressed.
-Sexual disorders mostly in female patients.
Causes
Female gender, females are highly susceptible to Addison’s disease as compared to males.
-Diagnosis of TB (tuberculosis)
-Infections.
-Traumatic injury to glands.
-Hemorrhage/Internal bleeding into the adrenal glands.
-Abnormal pituitary gland functioning.
-Abnormal autoimmune activity.
-History of autoimmune disorder in the family (close relative)
-Cushing’s disease and its treatment.
-Using blood thinner for a longer period of time.
-Diagnosis of Amyloidosis.
-Spread of cancer to adrenal glands from other organs or tissues.
-Diagnosis of adrenoleukodystrophy.
-Primary and secondary adrenal insufficiency that are explained in detail below:
- Primary adrenal insufficiency: It occurs when adrenal glands are no longer able to produce hormones due to damage to them. Damage to adrenal glands occurs when the immune system attacks them. Hence, this disease is also known as an autoimmune disease. In an immune disease, the autoimmune system mistakes an organ as an outsider like viruses or bacteria, and attacks them.
Causes of primary adrenal insufficiency include:
-administration of glucocorticoids for a long period of time.
-Body infections.
-Some kind of cancer or abnormal tumor growth.
-Prescribed blood thinner to avoid blot clots.
- Secondary adrenal insufficiency: This occurs when the pituitary gland is unable to produce adrenocorticotrophic hormone (ACTH). ACTH acts as a signal for adrenal glands for hormone production. If corticosteroid medications are not taken, it is also possible to develop adrenal insufficiency as it helps to control chronic health issues such as asthma.
Causes of secondary adrenal insufficiency include:
-Possible tumor in the body.
-Prescribed medications.
-Genetic composition.
-A brain injury that is traumatic in nature.
Prevention
The prevention of Addison's disease includes symptom relief and preventing a high-stress full environment that might lead to Addison’s disease. As a measure of prevention, the treatment of the underlying condition that causes Addison's disease is given, and limiting the risk factors of Addison’s disease like autoimmune disorders is also beneficial.
The following measures also play a role in the prevention of Addison’s disease:
- Treatment of fungal infection.
- Keeping diabetes under control.
- Identifying cancer symptoms for early diagnosis to prevent spread into adrenal glands and the bloodstream.
- Treatment of bacterial infections such as tuberculosis.
- Reducing stress levels by engaging in relaxing activities and tactics would prevent severe symptoms as well as complications.
Treatment
- Hormone replacement therapy:
Replacement of cortisol occurs with corticosteroids (mostly hydrocortisone) which are taken twice or thrice a day orally. Rarely, prednisone and dexamethasone are also prescribed. If aldosterone is not produced, fludrocortisone is prescribed. The main function of this medication is to balance the amount of sodium and fluid in your body.
- IV injections: Immediate IV injections of corticosteroids with a large amount of IV saline, and a salt solution with added dextrose (type of sugar) are also given.
- Surgery: IV corticosteroid and saline IV is given prior to surgery and after its completion till the patient is fully away and is able to take medications.
Tests Required for Diagnosis
Physician would perform a physical examination.
-Medical history of tuberculosis or autoimmune disorders (recent infections)
-A blood test to determine hormone and electrolyte levels.
-Stimulation test of the adrenocorticotrophic hormone.
-Insulin-induced hypoglycemic test.
-Diagnostic imaging for gland condition assessment.
Useful info
One should always carry a medical alert card or bracelet which will inform the medical staff about your condition and treatment in case of an accident or medical emergency. Medical staff would be well informed in case of incapacitation.
-Extra medications should be available readily. This includes keeping a small supply of medication at workplaces, travel bags, cars, etc. This way none of the doses of medication are missed even if they are forgotten to be carried along.
-It is a good idea to have a prescription of an injectable form of corticosteroids from a doctor and keep a supply of it with a needle and syringe to use it in case of emergency.
-Do not ignore critical symptoms like muscle weakness, weight loss, fatigue, and low blood pressure that gets worse with time.
-Do not miss your follow-up visits, since it helps a provider to evaluate the adequacy of doses for replacement hormones. Few adjustments are required in doses if the symptoms persist for a longer period of time which would be determined by a healthcare provider.
References
- FactDr (2021, February 1). Addison’s Disease. Factdr. Retrieved April 26, 2023, from https://factdr.com/health-conditions/addisons-disease/
- Addison Self Help Group (2021, February 1). Our Clinical Advisors. Addisondisease. Retrieved April 26, 2023, from https://www.addisonsdisease.org.uk/our-clinical-advisors
- Diseasedic.com (2023, January 1). Addison’s Disease – Causes, Prevention, and Treatment. Diseasesdic. Retrieved April 26, 2023, from https://diseasesdic.com/addisons-disease-risk-factors-causes-prevention-and-treatment/
- National Institue of Diabetes and Digestive and Kidney Diseases. (n.d.). Treatment for Adrenal Insufficiency & Addison's Disease. Niddk.nih.gov. Retrieved April 26, 2023, from https://www.niddk.nih.gov/health-information/endocrine-diseases/adrenal-insufficiency-addisons-disease/treatment
- Biggers, A. (2019, December 7). Addison's Disease. Healthline. Retrieved April 26, 2023, from https://www.healthline.com/health/addisons-disease#causes
