Addisons Disease: Information on Causes, Diagnosis & Treatments

Adrenal Gland Addison’s Disease (adrenal insufficiency) is a rare hormonal disorder of the endocrine system that affects approximately one out of every 100,000 individuals. Males and females are afflicted equally in every age group. Common symptoms associated with Addison’s disease includes fatigue, muscle weakness, weight loss, low blood pressure, and others. The disease is the result of the adrenal glands inability to produce sufficient amounts of cortisol hormones or aldosterone hormones. Because of that, the disease is often referred to as hypocortisolism or chronic adrenal insufficiency.

The body requires cortisol for healthy functioning and to assist in responding to stress. The hormone also regulates protein, carbohydrates, and fats in the body. It also controls inflammation and maintains cardiovascular function in blood pressure. Aldosterone hormones are crucial to a healthy life because they assist the kidneys and regulating water and salt levels in the body. This balance regulates blood pressure and blood volume. If the level of aldosterone hormones drops, the kidneys cannot maintain the critical balance of salt and water which would lead to low blood pressure.

Adrenal Insufficiency Causes

To determine the cause of the disease, a diagnostician will test the patient to determine if they are suffering from primary or secondary adrenal insufficiency or long-term infection that caused damage to the adrenal glands.

  • Autoimmune Diseases – Seven out of every ten cases of Addison’s disease involve autoimmune disease when the adrenal glands are mistakenly attacked by the body’s immune system and destroy the glands’ outer layer.

  • Long-Term Infections – the adrenal glands can be hard by long-lasting infections including HIV, tuberculosis, and some fungus infections. Metastasized (spreading) cancer cells from other areas of the body that affect the adrenal glands can lead to Addison’s disease. In some rare cases, individuals will develop adrenal insufficiency because of a bacterial infection.

  • Secondary Adrenal Insufficiency – Though rare, the adrenal glands can be harmed through secondary adrenal insufficiency when the hypothalamus or pituitary gland in the brain malfunctions. Both of these glands release hormones from the brain to the rest of the body that switches off the production of all other necessary hormones. If the malfunctioning pituitary gland produces ACTH (adrenocorticotropic hormone) the adrenal glands can remain in a mode where they no longer produce any hormones.

Secondary adrenal insufficiency can also be developed from the improper or prolonged use of prednisone and other steroid hormones. Radiation treatment or surgery of the pituitary gland can also cause damage leading to secondary adrenal insufficiency.

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Who Gets Addison’s Disease?

Some individuals are at greater risk of developing Addison’s disease than others. Typically, the individual will have had cancer, is taking blood thinners (anticoagulants), has had tuberculosis or another chronic infection, had a portion of their adrenal gland surgically removed or have been diagnosed with an autoimmune disease like Graves’ disease or Type I diabetes.

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The Signs and Symptoms of Addison’s Disease

Typically, individuals experience signs and symptoms of Addison’s disease that slowly become progressively worse. This is because the levels aldosterone hormones and cortisol slowly diminish and produce a steadily worsening, chronic condition that produces weight loss, loss of appetite and fatigue. In addition, common adrenal insufficiency symptoms include:

  • Salty food craving because the body is losing salt
  • Lowering blood pressure that produces lightheadedness or dizziness when standing
  • Diarrhea, vomiting, and nausea
  • Weakened muscles
  • Muscle spasms
  • Emotional changes including depression and irritability
  • Inappropriate and unexpected weight changes due to the increase of adrenocorticotropic hormone released from the pituitary gland.

The slowly progressing chronic symptoms associated with adrenal insufficiency (Addison’s disease) are often overlooked, ignored, or missed by doctors and patients until some event occurs including the need to undergo surgery, an accident, or the development of a flu virus. This is because these events tend to precipitate a need for a response from the adrenal glands that does not occur. Doctors refer to this medical emergency as an adrenal crisis.

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Diagnosing Addison’s Disease

There is no single test to verify Addison’s disease or adrenal insufficiency. Because of that, the doctor will perform numerous tests and evaluations before prescribing medications to regulate the hormonal output of the adrenal gland. Diagnosing the condition requires:

  • A comprehensive medical history detailing the patient’s experienced symptoms.

  • Verification of adrenal insufficiency related darkening (hyperpigmentation) of the gums or skin

  • A previous diagnosis of commonly associated conditions including a thyroid condition, gonadal/ovarian failure, insulin-dependent diabetes, B12 deficiency, loss of skin pigment (vitiligo), and gluten/lactose intolerance (celiac).

  • Routine blood tests that could show elevated bloodstream associated potassium and sodium levels, a significant change in white blood cell counts, unexpected chest x-rays and an EKG results caused by low blood volume and high potassium levels.

  • Insulin-Induced Hypoglycemia Test to rule out secondary adrenal insufficiency caused by a pituitary disease. This includes a blood glucose (blood sugar) and cortisol level tests.

  • ACTH (adrenocorticotropic hormone) Stimulation Test (Synacthen Test) to verify the diagnosis.

  • Antibody (serology) Tests to determine causation along with tuberculosis/infection screening, x-rays, skin test, blood test, and adrenal gland CT scans.

In addition to performing the test above, the doctor will also perform other tests to diagnose adrenal insufficiency to help identify antibodies related to the autoimmune disease. This includes an abdominal ultrasound, antibody blood test, and tuberculin skin test.

Treating Adrenal Insufficiency

Typically, the doctor will prescribe oral corticosteroids or injections as a part of hormonal replacement therapy for the treatment of Addison’s disease. The injections or oral medications can help adjust steroid hormone levels in the body that are no longer being produced sufficiently. These include:

  • Corticosteroid injections are typically prescribed when the patient is too ill to retain the oral drug without vomiting

  • Oral corticosteroids are prescribed to replace aldosterone and cortisol drugs including prednisone, hydrocortisone, cortisone acetate and fludrocortisone.

In addition, the doctor will usually recommend a sufficient amount of sodium intake, especially when the patient is exerting sufficient energy during exercise, or in hot weather, or experiencing gastrointestinal upsets including diarrhea. Temporary dosage adjustments are often made by the doctor when the patient is experiencing stressful situations including a minor illness, an infection, or when undergoing a surgical operation.

Diet and nutrition choices are also beneficial to minimize the potential dangers of suffering from the autoimmune disease. The doctor will typically provide specific guidelines and suggestions to ensure that the patient is receiving adequate amounts of sodium.

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Treating Addisonian Crisis

Patients suffering from an Addisonian crisis, or an adrenal crisis, are typically in the midst of a medical emergency. This life-threatening situation is usually the result of high bloodstream potassium levels, low bloodstream sugar levels, and low blood pressure. Treatments for an adrenal crisis include the use of dextrose (sugar), saline solution, and hydrocortisone.

The individual suffering with adrenal insufficiency must consistently pay attention to their body during times of intense stress including when pregnant, suffering a severe injury, undergoing a surgical procedure, or when sick. This also includes exercising and participating in strenuous sports activities, or working night shifts that can produce a dramatic negative effect on the body’s cortisol levels. After the stressful situation is over, patients can typically return to normal routines and regular doses of medication and sodium.

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Sources:

http://www.mayoclinic.org/diseases-conditions/addisons-disease/home/ovc-20155636

https://my.clevelandclinic.org/health/articles/addisons-disease

http://www.mayoclinic.org/diseases-conditions/addisons-disease/symptoms-causes/dxc-20155757

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/diseases-of-the-adrenal-gland/

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