Addison’s Disease

By Naomie Natasha

 

Addison’s disease is a hormonal disease which develops when adrenal glands do not produce enough hormones. Adrenal glands are 2 tiny glands that are positioned on top of the kidneys and make aldosterone and cortisol hormones.

If the adrenal glands are damaged in our bodies, the required hormones of cortisol and aldosterone are produced in insufficient quantities leading to Addison’s disease. This disease affects both men and women and is common between the ages of 30-50 (1).

Cortisol is responsible for regulating your body reaction to stressful circumstances. On the other hand, Aldosterone hormone is responsible for regulating sodium and potassium in our bodies. Sex hormones such as androgens are also produced by adrenal glands.

 

Signs and Symptoms of Addison’s Disease

The Addison’s disease symptoms mostly begin to show slowly and become worse when a stressful situation such as illness occurs. The signs and symptoms include the following;

  • Low blood pressure [In some cases, high blood pressure during an acute crisis which is known as a paradoxical response]
  • Extreme fatigue
  • sexual dysfunction in women
  • Irritability
  • Weight loss
  • Low blood sugar
  • abdominal pain
  • salt craving and darkening of your skin

 

If ignored, these problems become worse overtime and one may experience fainting, acute adrenal failure which can cause life threatening shock. See your doctor immediately if you have these symptoms;

  • low blood pressure [In some cases, high blood pressure during an acute crisis which is known as a paradoxical response]
  • High fever
  • Restlessness
  • You feel very weak
  • You have pain in your lower back
  • High potassium and low sodium
  • have severe abdominal pain

 

Acute adrenal failure or addisonian crisis is life threatening hence call 911 immediately if you have the symptoms listed above.

 

Causes of Addison’s Disease

There are 2 types of Addison’s disease. One is primary adrenal insufficiency and the second is secondary adrenal insufficiency. In order to diagnose which type of Addison’s disease you have, your doctor is supposed to identify based on the following info;

 

Primary Adrenal Insufficiency

This classification of Addison’s disease occurs when adrenal glands are injured making them to produce insufficient hormones. The cause of adrenal gland injury is often an autoimmune response where the immune system attacks the adrenal glands mistaking them to be foreign invaders.

Other causes of primary adrenal insufficiency include tumors of cancers, administration of glucocorticoids, blood thinners and infections in the body.

 

Secondary Adrenal Insufficiency

This classification of Addison’s disease occurs when the pituitary gland does not make adrenocorticotropic hormone which is responsible for signaling the adrenal glands to release their hormones.

The adrenal glands are part of endocrine system of the body. Their work is to give instructions to all tissues and organs in our bodies (2).

The hormone Cortisol

The adrenal glands are composed of 2 parts. The interior (medulla) and the outer layer (cortex).The outer layer produce the hormone Cortisol. Cortisol is essential for many body functions such as;

  • Works with adrenaline to aid the body to manage emotional and physical stress
  • Helps to maintain constant blood pressure in the body
  • Converts proteins into glucose
  • Reduces inflammation
  • Helps with smooth working of our immune system

 

Aldosterone Hormone

This is a mineralcorticoid of the adrenal glands that regulates electrolytes in the blood. This hormone plays a big role in the regulation of blood pressure. It balances the levels of potassium and sodium in the body. Aldosterone signals your kidneys and colon to put more sodium into the blood or excrete more potassium into your urine.

If the adrenal glands do not make enough of this hormone, you get low blood pressure.

 

People at Risk for Addison’s disease

  • If you take blood thinners or anticoagulants
  • Have autoimmune disease such as Graves’s disease and Diabetes type 1
  • Have cancer tumors
  • Had surgery that affected pituitary and adrenal glands
  • Have chronic infections such as tuberculosis

 

Diagnosing Addison’s Disease

You doctor will write all your medical history and ask the signs and symptoms you are experiencing to determine if you have Addison’s disease. A complete detailed family history may be asked to determine if there are other endocrine disorders.

Lab tests may be done to check the levels of your sodium and potassium. Hormone levels may also be measured.

Biochemical tests are done to measure the levels of cortisol. Synacthen tests show the baseline level of cortisol and its response. A person suffering from Addison’s disease will show a flat response.

X-rays are conducted to determine if there are visual signs of damage of adrenal glands.

Blood electrolyte tests will determine if a patient suffering from Addison’s disease needs mineralocorticoid replacement or not.

 

Treatment of Addison’s Disease

Treatment of this disease is paramount to prevent it from progressing to a life threatening condition.  Life threatening condition is characterized by shock, low blood pressure, low blood sugar and high levels of potassium in the blood.

A person suffering from Addison’s disease needs boost or replacement of the hormones needed for the normal functioning of the body. Glucocorticoid replacement is prescribed for people with primary and secondary Addison’s disease.

Hormonal replacement is also important in order to replace the ones that adrenal glands are not making.

The replacement therapy is for life and you may be needed to manage your fatigue. If cortisol is produced in insufficient amounts, hydrocortisone  (or an alternative medical steroid) will be prescribed to boost it.

 

Living with Addison’s Disease

Do not miss taking your life saving medications or make a mistake of taking them late since this can lead to exhaustion or insomnia (3 ).

If it is possible, make appointments with your endocrinologist after every 3 to 6 months to review your progress.

Keeping an emergency kit with your medication is helpful in case of emergency cases. This can be an injectable corticosteroid in case you go into shock after an injury or stressful event (emotional and/or physical) or you are not able to take tablets. Also have your doctor write you a crisis letter to include in your kit so that medical responders will know what to do if you do go into shock.

Please don’t forget that Addison’s disease can be fatal if left untreated.

Don’t forget to take your medication to avoid adrenal crisis which is a medical emergency. Inform your loved ones and caretaker of the emergency protocol in the case of adrenal crisis. This is vitally important, as an adrenal crisis can lead to death.

 

References

  1. Herder WW, van der Lely AJ (May 2003). “Addisonian crisis and relative adrenal failure”. Reviews in Endocrine and Metabolic Disorders. 4 (2): 143–7. doi:10.1023/A:1022938019091. PMID 12766542.
  2. Nieman LK, Chanco Turner ML (2006). “Addison’s disease”. Clinics in Dermatology. 24 (4): 276–280. doi:10.1016/j.clindermatol.2006.04.006. PMID 16828409.
  3. Ten S, New M, Maclaren N (2001). Clinical review 130: Addison’s disease 2001. The Journal of Clinical Endocrinology and Metabolism. 86 (7): 2909–2922. doi:10.1210/jc.86.7.2909. PMID 11443143.