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Addison's disease

Definition


Disease: Addison's disease Addison's disease
Category: Endocrine and metabolic diseases
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Disease Definition:

Also called adrenal insufficiency or hypocortisolism, Addison's disease occurs when the adrenal glands produce insufficient levels of the hormones aldosterone and cortisol.

This disease can be life-threatening and although it can occur at any age, it is most common in people between 30 and 50 years old. To treat Addison's disease, the patient will be given hormones that mimic the beneficial effects of those naturally made ones by replacing the insufficient amounts being made by the adrenal glands.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

The signs and symptoms of this disease develop slowly usually over several months, and may include:

  • Craving salt
  • Irritability
  • Weight loss and decreased appetite
  • Nausea, diarrhea or vomiting
  • Depression
  • Hypoglycemia (low blood sugar)
  • Hyperpigmentation, which is darkening of the skin
  • Muscle weakness and fatigue
  • Low blood pressure, even fainting
  • Muscle or joint pains
  • Addisonian crisis, also known as acute adrenal failure

The signs and symptoms of addisonian crisis (acute adrenal failure) may be:

  • Loss of consciousness
  • Severe vomiting and diarrhea, which leads to dehydration
  • High potassium (hyperkalemia)
  • Low blood pressure
  • Pain in the lower back, abdomen or legs

However, in some cases, the signs and symptoms of Addison's disease may appear suddenly.

Causes:

Situated just above each of the two kidneys, the adrenal glands are composed of two sections. The interior (medulla) produces adrenaline-like hormones and the outer layer (cortex) produces a group of hormones called corticosteroids, which include glucocorticoids, mineralocorticoids and androgens, which are the male sex hormones.
These glands are part of the endocrine system and produce hormones that give instructions to virtually every organ and tissue in the body. Some of the hormones that the cortex produces, such as the mineralocorticoids and the glucocorticoids, are essential for life.

Mineralocorticoids:
These hormones keep the blood pressure normal by maintaining the body's balance of sodium and potassium and water. Aldosterone is one of them.

Glucocorticoids:
These hormones include cortisol, and help the body to respond to stress, influence the body's ability to convert food fuels into energy and play a role in the immune system's inflammatory response.


PRIMARY ADRENAL INSUFFICIENCY:
When the cortex is damaged and doesn't produce its hormones in adequate quantities, Addison's disease occurs. Primary adrenal insufficiency is a term that is used to describe the condition involving damage to the adrenal glands.

Autoimmune disease can result in the failure of the adrenal glands to produce adrenocortical hormones. For an unknown reason, the immune system views the adrenal cortex as foreign, as something to attack and destroy.

Some of the other causes of adrenal gland failure may include:

  • Bleeding into the adrenal glands
  • Tuberculosis
  • Other infections of the adrenal glands
  • Secondary adrenal insufficiency
  • Spread of cancer to the adrenal glands

If the pituitary gland is diseased, adrenal insufficiency can occur. The pituitary gland produces adrenocorticotropic (ACTH) hormone, which stimulates the adrenal cortex to product its hormones. Even though the adrenal glands aren't damaged, inadequate production of ACTH can lead to insufficient production of hormones normally produced by the adrenal gland, a condition, which is called secondary adrenal insufficiency.

When people who take corticosteroids for treatment of chronic conditions, such as asthma or arthritis, abruptly stop taking them, secondary adrenal insufficiency occurs.

ADDISONIAN CRISIS:
An Addisonian crisis may be provoked by physical stress if someone has an untreated Addison's disease such as injury, infection or illness.

Complications

Complications:

None

Treatments:

Treatment for an early diagnosed Addison's disease may involve taking prescription corticosteroids. In order to replace the deficiency of the body's production of steroid hormones, the patient may have to take one or more hormones. Cortisol is replaced using hydrocortisone, prednisone or cortisone acetate. Fludrocortisone replaces aldosterone, which controls the body's sodium and potassium needs and keeps the blood pressure normal.

To minimize side effects, these hormones will be taken orally in daily doses similar to the amount the body normally makes. The patient may be suggested to temporarily increase the dosage when facing a stressful situation, such as an operation, an infection or a minor illness. Corticosteroid injections will be needed in case the patient is sick with vomiting and can't retain oral medications.

A person with Addison's disease may also be recommended dehydroepiandrosterone, which is an androgen replacement for treatment of androgen deficiency. Some studies show that androgen replacement therapy for women who suffer from Addison's disease may improve the overall sense of well-being, libido and sexual satisfaction.

ADDISONIAN CRISIS:
This condition is a life-threatening situation that requires immediate medical care and results in low blood pressure, low blood levels of sugar and high blood levels of potassium. Intravenous injections of hydrocortisone, saline solution and sugar (dextrose) may be included in the treatment of Addisonian crisis.

Prognosis:

Not available

Expert's opinion

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