Addison’s Disease

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Addison’s Disease (AD) is a rare disorder that occurs when the adrenal glands are damaged and it’s outer part–the cortex can no longer produce enough adrenocortical hormones, which are aldosterone and cortisol.  The aldosterone function is to regulate the balance of potassium and sodium in the blood, while the cortisol function is to maintain and […] Read More

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Addison’s Disease

Addison’s Disease (AD) is a rare disorder that occurs when the adrenal glands are damaged and it’s outer part–the cortex can no longer produce enough adrenocortical hormones, which are aldosterone and cortisol.  The aldosterone function is to regulate the balance of potassium and sodium in the blood, while the cortisol function is to maintain and regulate the blood pressure, immune system, heart function, and sugar level in the blood. In the case of a panic or traumatic attack, the cortisol responsively reduces your stress level by controlling its functions. With the absence of these hormones, the body weakens and there can be severe damage to the brain. It is also referred to as “adrenal insufficiency”, “hypoadrenalism”, or “hypocortisolism”. It is very uncommon and happens in about 1 in 100,000 people. It can happen to both males and females and all age groups, but it mostly occurs to people between the ages of 30 to 50 years.
  • Autoimmunity
The body’s immune system is designed to fight infections and diseases that pose harm to the body. But in the case of a defect, the immune system can begin to attack the body’s organ, causing damage to them, this is autoimmunity. An immunity defect can use the immune system to start fighting and harming the outer layers of the adrenal glands that secrete cortisol and aldosterone, leading to Addison’s disease.
  • Genetic Disorders
Certain genetic traits can lead to autoimmune problems or can cause direct damage to the adrenal glands, which can lead to Addison’s disease. They include:
  • X-linked adrenoleukodystrophy (ALD)
  • Hypothyroidism
  • Type 1 Diabetes
  • Vitiligo
  1. Infections such as bacterial, viral, and fungal; tuberculosis (TB), HIV related infections, etc.
  2. Amyloidosis; in which a protein builds up in the adrenal gland and damages it.
  3. Injury or hemorrhage into the adrenal glands
  4. Cancer cells that spread to your adrenal glands
  5. Adrenalectomy; a surgery performed to remove a tumor from the adrenal glands, or the adrenal glands.
Diagnosis  A physical and medical history examination by your doctor can give him a clue to test for Addison’s disease. Some tests include:
  • Blood Test; to test for the level of hormones (cortisol and aldosterone), sodium, and potassium in your blood. And to measure the level of the hormone that stimulates the adrenal cortex to produce its hormones–adrenocorticotropic hormone (ACTH).
  • ACTH Stimulation Test; an artificial ACTH is injected to examine the response of the adrenal glands to the hormones.
  • Imaging Tests; CT and X-rays can be used to check for the size and abnormalities of the adrenal glands
Treatments The treatments for Addison’s disease are for life. They have to be taken always to prevent it from becoming an Addisonian crisis and if it has gotten to the crisis stage, the drugs are given to prevent it from leading to cerebral defects, coma, and maybe death. There are medications (artificial hormones) that are induced to help produce adrenocortical hormones. They are referred to as corticosteroid drugs and can be given through the veins or orally. They include:
  • Fludrocortisone acetate to replace aldosterone.
  • Hydrocortisone to replace cortisol.
Other drugs may include:
  • Prednisolone 
  • Methylprednisolone
  • Dexamethasone
  • Glucocorticoids to stop inflammation.
You will be advised to increase your intake of sodium (salt) especially when you are stressed, after an exercise, when you are experiencing a gastrointestinal, bacterial, or infectious illness, have undergone an operation, and during hot weathers. Precautionary Measures A case of emergency can arise at any time especially when you have an advanced condition, Addisonian crisis. When you are under a lot of stress or in an accident, operation, or suffering from an illness that exhausts you, your adrenal glands produce more hormones that help you cope and manage, and keeps you from going into shock. But with Addison’s disease, the glands can not do so and you are at risk of going into shock which can lead to cerebral dysfunction, coma, and in some cases, death. Knowing that you are prone to these attacks at any time due to unforeseen circumstances, you have to follow the stated instructions:
  1. Always have your medications stocked up. Several prescribed injectable corticosteroids should always be available for you.
  2. Have an emergency kit with all your medications contained in it at all times, especially the injectable corticosteroids. Keep it handy and around you always.
  3. Always keep your medical alert bracelet on your wrist and carry your medical alert card with a written action plan around with you every time to keep people around you aware and alert.
Once you have been diagnosed with Addison’s disease, you should know it is a lifelong disease with medications taken every day. Always keep in touch with your doctor for treatment advice and adjustments if there are any, and go for regular check-ups.

Symptoms

Symptoms

The damage to the adrenal glands can happen slowly and so, Addison's disease tends to develop at a slow rate and can take several months. Since the symptoms are not noticeable or misconstrued at first, the disease can advance to a more critical stage where symptoms become more intense before you may take it seriously enough to get diagnosed.

The most chronic stage of symptoms is called the “Adrenal Crisis“, “Addisonian Crisis“, or “Acute Adrenal Insufficiency“, which happens when Addison's disease is untreated for a long time even when the more intense symptoms have begun to show. This stage is critical and life-threatening, and can quickly lead to a permanent disability, shock, coma, or death if professional medical help is not involved fast enough.

Initial symptoms may include:

  • Lethargy; fatigue, and tiredness.
  • Weak muscles
  • Dehydration and frequent thirstiness
  • Frequent urination
  • Salt cravings
  • Lack of appetite
  • Mood swings, irritability, and depression.
  • Sleeplessness
  • Weight loss

Later symptoms may include: 

  • Abdominal pains
  • Muscle and joint pains and cramps 
  • Cold sensitivity
  • Nausea and vomiting
  • Diarrhea
  • Mouth sores
  • Dizziness, lightheadedness, and drowsy feelings.
  • Fainting spells
  • Low blood pressure
  • Reduced heart rate
  • Hypoglycemia; low blood sugar
  • Hyperpigmentation; discoloration or darkening of the skin in areas such as the joints, palms, lips, gums, scars, etc.
  • Hair loss
  • Reduced sexual libido
  • Sexual dysfunction in females; menstrual irregularity or seizure.

Addisonian crisis symptoms include:

  • Severe dehydration
  • Agitation, fear, and delirium
  • Confusion and restlessness
  • Hallucinations
  • Cold shivers
  • Pale and clammy skin
  • Profuse sweating
  • Severe diarrhea and vomiting
  • Migraine
  • Dizziness
  • Rapid, heavy, and shallow breathing
  • Weakness
  • High fever
  • Chronic abdominal, leg, and back pains.
  • Faint feeling
  • Reduced or loss of consciousness.

Causes

Causes

Addison's disease occurs when the outer part of the adrenal glands (cortex) is damaged and can no longer produce the adrenocortical hormones (cortisol and aldosterone), or produces little that can not be enough for the body's functions.

There are several possible causes of this disease and they include:

    FAQ

    What makes Addison's disease worse?

    Any action that increases your stress level such as surgery, accident, trauma, infection, etc, can worsen the symptoms. This is because the small or no production of cortisol and aldosterone means your body can no longer cope with stress. 

    What foods should you avoid with Addison's disease?

    Avoid foods and drinks such as:

    • Soda 
    • Caffeine
    • Alcohol
    • Processed and fast food.
    • Fried food
    • White flour and sugar

    Is Addison's disease hereditary?

    Some causes of AD are related to the genes. So, in very rare cases, the disease can be hereditary.

    Is Addison's disease deadly?

    Addison's disease is a life-threatening disease and once it is diagnosed goes on for a lifetime. Although the disease is a very rare one, there has been a high mortality rate for those who have the disease and have gotten to the Addisonian crisis stage.

    What is the life expectancy of Addison's disease?

    The life expectancy of AD is estimated to range between 3 to 11 years. The chance of death is reduced if you are your medications every day and take the necessary steps to keep your stress level under control in case of emergency.

    Can the Addisonian crisis cause mental illness?

    Yes, it can. The symptoms of Addisonian crisis comprises of some mental changes such as confusion, fear, anxiety, depression, delirium, hallucinations, encephalopathy, etc, and if the crisis is not treated, it worsens. In the case of a panic attack, where the stress level comes up high and a corticosteroid is not available to be injected. The brain goes into shock, then into a coma, which can lead to cerebral palsy, if the patient can survive death.