Addisons Disease
What is Addisons Disease
Addison’s disease is a hormonal disorder that occurs when the adrenal glands in the body (which reside just above your kidneys) don’t produce enough of the hormones cortisol (and or aldosterone). It’s the common name for the medical term hypoadrenocorticism or adrenal insufficiency. It occurs in all age groups and seems to affect both men and women equally. Having said that, it’s not something that occurs commonly - typically only affecting about one in 100,000 people.
Addisons Disease Medical Symptoms
Addisons disease is typically characterized by loss of weight, weakness in the muscles, tiredness/fatigue, low blood pressure(which can cause fainting episodes), and at times a darkening of the skin in areas of the body. People with Addisons disease are commonly irritable and can be depressed. They also tend to crave salty foods. Hypoglycemia, or low blood sugar, is commonly seen in children with Addisons. And with some women, they may notice that their menstrual cycle becomes irregular or stop altogether. Addisons disease can be life threatening and these episodes are often referred to as an Addisonian crisis. Medical symptoms of an Addisonian crisis include sudden penetrating pain in the lower back, abdomen, or legs, severe vomiting and diarrhea, which is often followed by dehydration; low blood pressure; and loss of consciousness.
These medical symptoms occur as a direct result of the low concentrations of the hormones that the adrenal glands are supposed to produce. Let’s look at the hormones in detail. Starting with the usual one that’s reduced in Addisons disease - cortisol. Cortisol belongs to a class of hormones called glucocorticoids and this hormone pretty much has it’s foot in every the proper functioning of most organs in the body. Principally however, the most important function of cortisol is a stress regulator. When your body undergoes stress, it releases cortisol to cope with it and it does so by slowing the immune system’s inflammatory response, maintaining your blood pressure, regulating the breakdown of sugar for energy and the metabolism of proteins and fats. Control of the amount of cortisol released by the adrenal glands is maintained by the pituitary gland in your brain which releases a stimulatory hormone called ACTH (adrenocorticotropin) which triggers the adrenals to release cortisol into the circulatory system in response to stress. In Addisons disease the ability to release cortisol is markedly reduced and therefore the individual finds it impossible to deal with stressful situations. The other important hormone that is sometimes reduced in Addisons disease is aldosterone (which is in a class of hormones called mineralocorticoids). It’s primary function is to help the kidney regulate the salt and water balance in the body which in turn regulates blood pressure.
Causes of Addisons Disease
There are 2 general reasons for the failure of the adrenals to produce enough cortisol :
- Primary adrenal insufficiency - where the fault lies in the adrenal glands itself ie they cortisol producing cells have been destroyed by either autoimmune disorders (where the body decides for some reason or another to turn on itself and take out certain cell lines) or cancer.
- Secondary adrenal insufficiency - where the failure lies in the inadequate production of the stimulatory hormone ACTH from the pituitary gland. This can sometimes occur because a person’s taking medications like prednisone (a glucocorticoid) which sends signals to the brain that the body already has sufficient cortisol swimming around the system and therefore to halt the orders to make more. Other causes are the side effects of having had surgery for benign tumours of the pituitary gland and if the surgeon has taken too much out, then the result is Addisons disease.
Diagnosis of Addisons Disease
Addisons disease is notoriously hard to diagnose because the medical symptoms are vague and often mimic other illnesses. A series of blood/urine tests (ACTH Stimulation test, Insulin-Induced Hypoglycemia Test) are usually conducted to diagnose Addisons disease. Further tests include xrays and possible CT Scans of the adrenal and pituitary glands.
If the patient presents with an Addisonian crisis, the doctor will usually commence treatment first and then wait for the patient to stabilize before testing for Addisons disease.
Treatment of Addisons Disease
Generally, treatment involves oral replacement of the hormones that are lacking - synthetic glucocorticoids are taken once or twice daily. If aldosterone is also deficient, then another drug called fludrocortisone is taken orally once daily, at the same time, most of these patients are also advised to increase their intake of salt in their diet. In addition to this, most patients are also told to avoid stressful situations if possible and if they anticipate a stressful event in the near future to adapt their dosage regime to cater to the increase requirement for cortisol in their body - these events would include potential surgery, pregnancy. It’s also advised to tell their family members and loved ones about the symptoms of an addisonian crisis and to have an action plan devised if it occurs - this usually involves injecting the patient with cortisol. Medic Alert bracelets are a life saver and a necessity in these situations.