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Home > Disease > Addison's Disease

Addison's Disease

Addison's Disease

Overview of Addison's Disease

Addison's disease is a condition where your adrenal glands don't produce enough cortisol or aldosterone. It's often caused by an autoimmune attack. There are medications that can help with symptoms, so it's not fatal.

What is Addison's Disease?

Addison's disease is an endocrine disorder in which your adrenal glands don't produce enough cortisol and aldosterone, leading to a variety of symptoms.

Adrenal glands, which are also called suprarenal glands, are small triangular-shaped glands that sit on top of the kidneys. They are a part of the endocrine system and work with other glands to control a variety of body processes including blood pressure, inflammation, moods and how we respond to stress.

Cortisol is a hormone that helps your body respond to stress, including the time of illness, injury or surgery. It also helps main a healthy blood pressure, heart function, immune system and sugar levels. Cortisol is key to survival.

Aldosterone is a hormone that has effects on the amount of sodium, potassium and fluid your kidneys remove. These have an effect on blood volume and blood pressure.

Addison's disease is also called adrenal insufficiency. A related disorder, secondary adrenal insufficiency, occurs when your pituitary gland does not produce enough adrenocorticotropic hormone (ACTH), which will activate the adrenal glands and produce cortisol.

Who does Addison’s disease affect?

All age groups are susceptible to Addison's disease, however persons between the ages of 30 and 50 are the most frequently affected.

Addison's disease is far more prevalent in those with autoimmune polyendocrine syndrome, a rare, genetic illness in which the immune system unintentionally assaults numerous tissues and organs. The mucous membranes, adrenal glands, and parathyroid glands are the most common organs and tissues that are affected by this condition, while it can also affect other tissues and organs.

What are the symptoms of Addison’s disease?

The following signs and symptoms are possible for those who have Addison's disease:

  • muscle weakness
  • fatigue and tiredness
  • darkening in skin color
  • weight loss or decreased appetite
  • a decrease in heart rate or blood pressure
  • low blood sugar levels
  • fainting spells
  • sores in the mouth
  • cravings for salt
  • nausea
  • vomiting

Neuropsychiatric symptoms like the following may also be present in people with Addison's disease:

  • irritability or depression
  • lack of energy
  • sleep disturbances

An Addisonian crisis may develop if Addison's disease is left untreated for an extended period of time. The following symptoms may be present during an Addisonian crisis:

  • agitation
  • delirium
  • visual and auditory hallucinations

An Addisonian crisis is a medical emergency that poses a risk to life. If any of the following begin to manifest for you or someone you know:

  • mental status changes, such as confusion, fear, or restlessness
  • loss of consciousness
  • high fever
  • sudden pain in the lower back, belly, or legs

Shock and even death might result from an untreated Addisonian crisis.

What causes Addison’s disease?

An autoimmune response, which happens when your immune system targets healthy tissues for an unidentified reason, is the most frequent cause of Addison's disease. Your immune system targets the adrenal cortex, the outer layer of your adrenal glands where cortisol and aldosterone are produced, when you have Addison's disease. It can take months or years for 90% of the adrenal cortex to be destroyed before symptoms start to appear.

An autoimmune reaction causes Addison's disease in about 75% of patients. In particular, autoimmune polyendocrine syndromes I (APS type-1) and II are rare, hereditary diseases that can cause autoimmunity Addison's disease (Schmidt syndrome).

Historically, one of the main causes of Addison's illness was TB. In poor nations, it is still a major contributor to the condition.

  • These are some other, less typical causes of Addison's disease:
  • recurring infections, including fungal infections and infections linked to HIV/AIDS.
  • when your adrenal glands are invaded by cancer cells from another part of your body.
  • bleeding into your adrenal glands (haemorrhaging).
  • Your adrenal glands will be surgically removed.
  • Amyloidosis (a disorder in which amyloid proteins pile up in essential organs, causing harm) (a condition in which amyloid proteins build up in vital organs, causing damage).

Secondary adrenal insufficiency

Secondary adrenal insufficiency may result from anything that interferes with the pituitary's capacity to produce ACTH. The fact that the pituitary produces a variety of hormones suggests that ACTH may not be the sole hormone deficient.

There are several causes of secondary adrenal insufficiency such as:

  • autoimmune disease
  • pituitary tumors or infection
  • bleeding in the pituitary
  • genetic diseases that affect the way the pituitary gland develops or functions
  • surgical removal of the pituitary to treat other conditions
  • traumatic brain injury NIH external link

Tertiary adrenal insufficiency

Stopping corticosteroids abruptly after taking them for a long time is the most frequent cause of tertiary adrenal insufficiency. Cortisol levels in the blood may be higher than what your body ordinarily produces when you take corticosteroids on a prescription basis. Long-term high blood levels reduce CRH production in the hypothalamus. Less CRH results in less ACTH, and less ACTH in turn results in the adrenal glands ceasing to produce cortisol.

Your adrenal glands could take some time to start functioning normally if you stop using corticosteroids. Your doctor will gradually lower your dose over the course of weeks or even months to give your body time to begin producing cortisol once more. Even so, it may take several months for your adrenal glands to start functioning correctly. Your doctor should keep a close eye out for any signs of adrenal insufficiency in you.

After Cushing's syndrome has been treated, tertiary adrenal insufficiency can also happen. A hormonal disease called Cushing's syndrome is brought on by persistently high amounts of cortisol in the blood. Tumors in the pituitary or adrenal glands that produce too much ACTH or cortisol can occasionally be the cause of Cushing's syndrome. These tumours are often noncancerous. The cause of excessive ACTH or cortisol is rapidly eliminated after the tumours are surgically removed. Your adrenal glands could take a while to get going again.

Diagnosis of Addison’s disease

Addison's disease symptoms frequently cause a delay in getting the right diagnosis because they typically appear gradually over time, are ambiguous, and are shared by a number of different illnesses.

When a normal blood test, such as a basic metabolic panel, reveals low sodium or high potassium levels, healthcare professionals frequently "accidentally" find Addison's disease.

Dark patches on your skin are another usual sign that tells doctors to check you for Addison's disease.

Based on your symptoms, if your doctor thinks you could have Addison's disease, they'll conduct more tests to confirm the diagnosis.

Tests to diagnose Addison's Disease

The following tests may be prescribed by your doctor to check for Addison's disease:

  • Blood tests: To assess the amounts of sodium, potassium, cortisol, and ACTH in your blood, your doctor is likely to prescribe a few tests.
  • ACTH stimulation test: This examination gauges the reaction of your adrenal glands to an injection of synthetic ACTH. After the shot, your adrenal glands may not be working properly if they don't create much cortisol.
  • Insulin-induced hypoglycemia test: To ascertain whether your symptoms are caused by issues with your pituitary gland (secondary adrenal insufficiency) rather than your adrenal glands, your doctor may prescribe this test. This test compares the levels of blood sugar (glucose) before and after a fast-acting insulin injection, which is supposed to cause hypoglycemia, a reduction in blood sugar, and an increase in cortisol.
  • Computed tomography (CT scan): Through the use of computers, the imaging test known as computed tomography creates cross-sectional views from a number of X-ray pictures. To assess your pituitary and/or adrenal glands, your doctor might recommend a CT scan. For instance, it can reveal whether your immune system has harmed or infected your adrenal glands.

Treatment for Addison’s disease

The hormones cortisol and aldosterone that are lacking in Addison's disease are replaced by synthetic versions of each.

Medications

The drugs hydrocortisone and fludrocortisone, respectively, replace aldosterone and cortisol. You will always need to take medication because Addison's disease is a chronic condition.

To prevent an acute adrenal crisis while you are suffering with an infection, trauma, surgery, or other stressful events, your body needs a varying dosage of these medications from person to person doctor may raise the dosage.

Your doctor may advise you to consume more salt if you're taking fludrocortisone, particularly in hot and humid conditions and after strenuous exercise.

Home Care

Always have a supply of your prescriptions in an emergency pack. In case of an emergency, request a prescription for an injectable corticosteroid from your doctor.

To let others know about your condition, you might also wish to have a medical alert card in your wallet and a bracelet on your wrist.

Alternative therapies

If you have Addison's disease, you should try to reduce your stress levels. Major life events can increase stress and alter how you react to drugs, such as the death of a loved one or an injury. Consult your doctor about other stress-relieving techniques like yoga and meditation.

Complications of Addison's disease

A physical stressor such an injury, infection, event illness can trigger an addisonian crisis if Addison's disease is not managed. The adrenal glands frequently produce two to three times as much cortisol as usual in reaction to physical stress. An addisonian crisis can result from adrenal insufficiency because stress cannot enhance cortisol production.

A life-threatening condition known as an addisonian crisis is characterised by low blood pressure, low blood sugar, and high blood potassium levels You need to seek immediate medical attention.

Autoimmune illnesses are frequently co-occurring in people with Addison's disease.

Prevention of Addison's disease

Although it is impossible to prevent Addison’s Disease, there are things you can do to avert an addisonian crisis:

  • If you consistently feel weak or exhausted or if you're losing weight, consult your doctor. Inquire about your adrenal fatigue.
  • Ask your doctor for advice on what to do while you're ill if you have Addison's disease. You might need to figure out how to up your corticosteroid dosage.
  • Go to the emergency hospital if you feel very sick, especially if you are vomiting and unable to take your prescription.

Because they are aware that these side effects happen in patients who take hydrocortisone or prednisone for other conditions, some Addison's disease sufferers worry about major side effects from these medications.

The negative effects of high-dosage glucocorticoids should, however, be avoided if you have Addison's disease because the dose you are administered is making up for the lost amount. Follow up with your doctor periodically to make sure your dosage is adequate.

Diet for Addison's disease (Adrenal Insufficiency)

A high-sodium diet may help some Addison's disease sufferers with low aldosterone levels. A doctor or nutritionist can provide advice on the optimal sodium sources and the suggested daily sodium consumption.

A increased risk of osteoporosis, a disorder in which the bones become less thick and more prone to fracture, is associated with high dosages of corticosteroids. To protect your bone health if you use corticosteroids, you may need to include enough calcium and vitamin D in your diet. A doctor or dietician can tell you how much calcium you need based on your age. You may also need to take calcium supplements.

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