ni ada lg.. What is Addison’s disease?
Addison’s disease occurs when your body’s adrenal glands do not produce enough hormones. The adrenal glands are part of your body’s endocrine system, a group of glands that produce and secrete hormones to regulate your body’s processes. The adrenal glands are located just above your kidneys and produce adrenaline-like hormones and a class of hormones called corticosteroids.
Some of the corticosteroid hormones produced by the adrenal glands are essential for life. Glucocorticoids affect your body’s ability to convert food into energy, the immune system’s inflammatory response, and your body’s reaction to stress. Mineralocorticoids maintain your body’s balance of sodium, potassium and water.
In Addison’s disease, your adrenal glands do not produce enough cortisol, one of the glucocorticoids. Sometimes, your body also fails to produce enough aldosterone, one of the mineralocorticoids.
Addison’s disease is most common among people ages 30 to 50, but it can occur at any age and affects men and women equally. It is also called adrenal insufficiency or hypocortisolism. What causes Addison’s disease?
There are two types of adrenal insufficiency:
Primary adrenal insufficiency
Primary adrenal insufficiency occurs when the outer layer of the adrenal gland, which produces the corticosteroids, is damaged and doesn’t produce enough hormones. This is usually caused by an autoimmune disorder in which the body’s own immune system attacks the adrenal glands.
Other causes of adrenal gland failure are:
Secondary adrenal insufficiency
- Other infections of the adrenal glands
- Spread of cancer to the adrenal glands
- Bleeding into the adrenal glands
Secondary adrenal insufficiency occurs when you have another condition that causes the adrenal gland to fail to produce enough hormones. It can be caused by a diseased pituitary gland. The pituitary gland makes a hormone called adrenocorticotropic hormone (ACTH) that stimulates the adrenal glands to produce their hormones. If the pituitary gland is unable to produce enough ACTH, the adrenal glands will not be stimulated to produce their hormones.
When a person who has been receiving a glucocorticoid hormone (like prednisone) as treatment for another disorder abruptly stops taking it, the person may develop a temporary form of secondary adrenal insufficiency. What are the symptoms of Addison’s disease?
The symptoms of Addison’s disease usually develop over a period of several months and may include:
- Muscle weakness and worsening fatigue
- Weight loss and decreased appetite
- Darkening of the skin (hyperpigmentation)
- Low blood pressure, even fainting
- Salt craving
- Low blood sugar (hypoglycemia)
- Nausea, diarrhea or vomiting
- In women: irregular menstrual periods
Sometimes, the symptoms of Addison’s disease appear suddenly. This is called acute adrenal failure or Addisonian crisis and it can be fatal if it isn't treated. The symptoms may include:
How will my doctor know I have Addison’s disease?
- Pain in the lower back, abdomen or legs
- Severe vomiting and diarrhea, leading to dehydration
- Low blood pressure
- Loss of consciousness
Your doctor will perform laboratory tests to determine whether you have Addison’s disease:
How is Addison’s disease treated?
- Blood tests: Tests that measure the levels of sodium, potassium, cortisol and ACTH in your blood can help your doctor know whether an adrenal insufficiency is causing your symptoms. Your doctor can also measure antibodies associated with autoimmune disorders that can cause Addison’s disease.
- ACTH stimulation test: Your doctor may test your body’s ability to secrete cortisol in response to an injection of synthetic ACTH to find out if your adrenal glands are damaged. In a healthy person, cortisol levels rise after the ACTH injection.
- Insulin-induced hypoglycemia test: If your doctor suspects pituitary gland disease, he or she may test your blood sugar and cortisol levels at various points after an injection of insulin. Normally, glucose levels fall and cortisol levels rise after an insulin injection.
- Imaging tests: Your doctor may want to do a computerized tomography (CT) scan to check the size of your adrenal glands or pituitary gland and look for abnormalities that could help identify the cause of your adrenal insufficiency.
Treating Addison’s disease usually involves taking prescription corticosteroids to replace the hormones your body is not making. Cortisol is supplemented by a synthetic glucocorticoid like hydrocortisone, prednisone or cortisone. Aldosterone is replaced by a mineralocorticoid called fludrocortisone.
Your doctor may also recommend you take an androgen replacement called dehydroepiandrosterone. Some women with Addison’s disease find that taking replacement androgen improves their overall sense of well-being, libido and sexual satisfaction.
If you are experiencing an addisonian crisis, you need immediate medical care. The treatment typically consists of intravenous (IV) injections of hydrocortisone, saline (salt water) and dextrose (sugar). What should I do after my doctor has diagnosed Addison’s disease?
You should be well-equipped to handle a medical emergency if you have Addison’s disease:
- Carry a medical alert card and bracelet at all times so that emergency medical personnel know what kind of care you need.
- Keep extra medication with you in case you forget to take your pills. Have your doctor give you a prescription for an injectable form of corticosteroids for use in emergency situations.
- Stay in close contact with your doctor to help make sure your doses of replacement hormones are appropriate