Addison’s Disease/Adrenal Insufficiency

Addison’s Disease/Adrenal Insufficiency

By Jill L. Smith

Have you ever heard of a disease with many different names??

Well, there is a specific disease with many different names and here they are:

  • Hypocortisolism
  • Hypoadrenalism
  • Primary Hypoadrenalism
  • Chronic Hypoadrenalism
  • Adrenocortical Hypofunction
  • Chronic Primary Congenital Addison’s Disease
  • Addison’s Disease
  • Primary Addison’s Disease
  • Secondary Addison’s Disease
  • Adrenal Insufficiency
  • Primary Adrenal Insufficiency
  • Secondary Adrenal Insufficiency
  • Chronic Adrenal Insufficiency
  • Hypoadrenocorticism Familial
  • Primary Adrenocortical Insufficiency (Disorder)

To make it easy, I am going to use the term, Addison’s Disease or AD, to refer to all of the above terms.

Addison’s Disease is a rare, life-threatening disease that occurs when your body doesn’t produce any or enough of a certain amount of specific hormones that are produced in the adrenal glands. AD occurs in all age groups and affects both males and females. It occurs in approximately 5-10 in 1,000,000 people.

Addison’s Disease results when your adrenal glands are damaged or removed.  The adrenal glands are located on top of each kidney. The hormones cortisol and aldosterone are in virtually every organ, cell and tissue in your body.

Corticosteroids are essential to sustain life. It is divided into two classes:

  • Glucocorticoids including Cortisol
  1. required for energy
  2. your inflammatory response
  3. helps the body respond to stress
  • Mineralocorticoids including Aldosterone
  1. Keep your blood pressure normal
  2. Balance sodium and potassium

And Androgens are male sex hormones

  1. Produced in both men and women
  2. Provide sexual development in men
  3. Influence muscle mass
  4. Produce libido and a sense of well-being in men and women

Each person with AD can have different symptoms. Here are some symptoms associated with AD:

  • Extreme fatigue
  • Weight loss and decreased appetite
  • Darkening of your skin (hyperpigmentation)
  • Low blood pressure, even fainting
  • Salt craving
  • Low blood sugar (hypoglycemia)
  • Nausea, diarrhea or vomiting
  • Abdominal pain
  • Muscle or joint pains
  • Irritability
  • Depression
  • Body hair loss
  • Sexual dysfunction in women
  • Sleep disturbances

Cortisol production is regulated by the pituitary gland, located at the base of the skull, and is responsible for the hormone ACTH or adrenocorticotropic hormone which tells the adrenal glands to produce cortisol.

Primary Addison’s Disease or Primary Adrenal Insufficiency results when the adrenal glands are not working properly or have been removed and don’t receive the signal from the pituitary gland to produce cortisol and aldosterone.

Secondary Adrenal Insufficiency or Secondary Addison’s Disease happens when the problem lies in the pituitary gland. The adrenal glands are working but never receive the signal due to problems in the pituitary gland.

Dr. Thomas Addison’s first described this disease in London in 1855. At that time the most common cause was tuberculosis. This remained the leading cause until the middle of the 20th century when antibiotics reduced TB.

Since then, the major cause of Addison’s Disease results from an autoimmune reaction in which the body’s own immune system makes antibodies against the cells of the adrenal cortex in the adrenal glands and slowly destroys them. That process can take months to years.

Other less common causes of Addison’s Disease include chronic infections including certain fungal infections, breast cancer cells that invade the adrenal glands, AIDS, and the surgical removal of both adrenal glands as well as removal of the pituitary gland or tumor removal in the pituitary.

The treatment for AD is to replace the missing cortisol with hydrocortisone, dexamethasone or prednisone and if Primary AD, replace aldosterone with Fludrocortisone.

In times of physical stress like surgery, accidents and illnesses, it is necessary to get IV steroids and fluids.

In times of mental stress either happy or stressful, it is necessary to “stress dose” which means to take extra oral steroids in order to avoid an Adrenal Crisis.

An Adrenal Crisis can be fatal! It is when the stressors are using up your oral steroids making one very sick and therefore extra IV or oral steroids are required.

Since Addison’s Disease is a chronic condition, daily replacement medication can never be stopped or death will surely happen.

A person with any type of AD must regularly maintain doctor visits, examinations and lab tests. There is no single blood or urine test that gives us answers therefore a panel of different ones and doctor visits are a must.

Every Addisonian should wear an identification bracelet stating that he or she has the disease, to insure proper emergency treatment. An identification card outlining treatment is also suggested.

It is important to bring awareness to this rare, life-threatening disease.

Awareness is Key!