ADDISON’S DISEASE (Elsie A.
Orok)
The condition also known as Adrenal insufficiency occurs when
the adrenal glands don’t make enough of the hormone cortisol. You have
two adrenal glands. They are located just above the kidneys. They work
with the hypothalamus and pituitary glands in the brain. Cortisol helps
break down fats, proteins, and carbohydrates in your body. It also
controls blood pressure and affects how your immune system works.
TYPES OF ADDISON’s DISEASE
Primary adrenal insufficiency. This is known as Addison's disease. It
occurs when the adrenal glands are damaged. They don’t make enough
of the hormones cortisol and aldosterone. This condition is rare. It may
occur at any age.
Secondary adrenal insufficiency. This starts when the pituitary gland
doesn’t make enough of the hormone ACTH (adrenocorticotropin). As a
result the adrenal glands don’t make enough cortisol.
WHAT ARE THE CAUSES OF ADRENAL
INSUFFICIENCY
Primary adrenal insufficiency is most often caused when your immune
system attacks your healthy adrenal glands by mistake. Other causes
may include:
-Cancer
-Fungal infections
-Tuberculosis infection of the adrenal glands
-Inherited disorders of the endocrine glands
A lack of the hormone ACTH leads to secondary adrenal insufficiency.
That can happen if you must take certain steroids for a long time due to a
health problem. For example, people with asthma or rheumatoid arthritis
may need to take prednisone. Other causes include:
-Pituitary gland tumors
-Loss of blood flow to the pituitary
-Pituitary gland is removed or you have radiation treatment of the
pituitary gland
-Parts of the hypothalamus are removed
WHAT ARE THE SYMPTOMS OF ADDISON’s DISEASE
-Weakness
-Fatigue
-Dizziness
-Dark skin (Addison's disease only)
Bluish-black color around the nipples, -mouth, rectum, scrotum, or
vagina (Addison's disease only)
-Weight loss
-Fluid loss (dehydration)
-Lack of appetite
-Muscle aches
-Upset stomach (nausea)
-Vomiting
-Diarrhea
-Low blood pressure
-Low sugar levels
-In women, irregular or no menstrual periods
If not treated, adrenal insufficiency may lead to:
Severe belly (abdominal) pain
Extreme weakness
Low blood pressure
Kidney failure
Shock
HOW CAN ADDISON'S DISEASE BE DIAGNOSED?
To determine if you have Addison’s disease, your healthcare
provider may order the following tests:
Blood tests: Your provider will likely order certain tests to
measure the levels of sodium, potassium, cortisol and ACTH in your
blood.
ACTH stimulation test: This test measures your adrenal
glands’ response after you’re given a shot of artificial ACTH. If your
adrenal glands produce low levels of cortisol after the shot, they
may not be functioning properly.
Insulin-induced hypoglycemia test: Your provider may
order this test to determine if your symptoms are due to problems
with your pituitary gland (secondary adrenal insufficiency) instead
of your adrenal glands. This test measures blood sugar (glucose)
levels before and after the injection of fast-acting insulin, which
should lead to a drop in blood sugar (hypoglycemia) and a rise in
cortisol.
Computed tomography (CT scan): Computed tomography
is an imaging test that uses computers to combine many X-ray
images into cross-sectional views. Your provider may order a CT
scan to evaluate your adrenal glands and/or pituitary gland. For
example, it can show if your immune system has damaged your
adrenal glands or if the glands are infected.
Treatment
Medicines are used to treat Addison's disease. Hormone
replacement therapy corrects the levels of steroid hormones the
body isn't making enough of. Some treatments include oral
corticosteroids such as:
Hydrocortisone (Cortef), prednisone (Rayos) or
methylprednisolone (Medrol) to replace cortisol. These
hormones are given on a schedule to act like the changes in cortisol
levels the body goes through over 24 hours.
Fludrocortisone acetate to replace aldosterone.
You likely need plenty of salt in your diet. This is especially true
during heavy exercise, when the weather is hot or if you have
digestive upsets, such as diarrhea.
Your health care provider may increase your medicine for a short
time if your body is stressed. Such stress can come from having
surgery, an infection or a minor illness. If you're vomiting and can't
keep down your medicine, you may need shots of corticosteroids.
Other treatment recommendations include:
Carry a medical alert card and bracelet at all times. A
steroid emergency card and medical alert identification let
emergency care providers know what kind of care you need. Also
have a written action plan.
Keep extra medicine handy. It can be dangerous to miss
even one day of medicine. So keep a small supply at work and with
you when you travel.
Carry a glucocorticoid injection [Link] kit contains a
needle, a syringe and an injectable form of corticosteroids to use in
case of emergency.
Stay in contact with your care [Link] care provider
can monitor your hormone levels. If you have problems with your
medicine, your provider might need to change the doses or when
you take them.
Have yearly checkups. At least once a year, see your care
provider or a doctor who treats hormone problems. Your provider
may recommend yearly screening for autoimmune diseases.
An addisonian crisis is a medical emergency. Treatment typically
includes IV:
Corticosteroids
Saline solution
Sugar
Potential future treatments
Researchers are working to develop delayed-release corticosteroids,
which act more like the hormones made by the human body. They
also are studying the use of pumps placed under the skin that can
deliver steroids in more-accurate doses.
Request an appointment
