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Addison's Disease

DEFINITION

Addison’s Disease is a disease of the adrenal glands, two small glands that sit on top of the kidneys. The adrenal glands are part of the endocrine system, which is the system that regulates hormones in the body. The hormones produced by the adrenal glands are extremely important to regulation and balance (homeostasis) of most of the organ systems in the body. There are two sections to the adrenal gland, the medulla and cortex. The inner section (medulla) produces hormones like adrenaline (also called epinephrine). The outer section (cortex ) is important for production of the corticosteroids. Corticosteroids produced in the cortex include mineralocorticoids (such as aldosterone), glucocorticoids (such as cortisol), and androgens (male sex hormones). The mineralocorticoids maintain salt balance and blood pressure in the body through control of sodium and potassium. The glucocorticoids affect the body’s ability to use fuels for energy, allow the body to cause inflammation to help the immune system and regulates the body’s ability to deal with stress. In Addison’s Disease, the body does not produce enough hormones from the adrenal glands. Most of the time, this damage is autoimmune in nature (a process where the body attacks itself). Generally this occurs due to damage to the cortex of the adrenal gland. This damage to the adrenal glands can also be caused by infection, tuberculosis, metastatic cancer which has spread to the adrenal gland, or hemorrhage (bleeding) into the adrenal gland. It is also possible also to have low levels of these hormones if the regulatory center in the brain (the pituitary gland) is not producing a regulatory chemical called ACTH which stimulates the adrenal glands. A lack of ACTH from the pituitary gland is called Secondary Adrenal Insufficiency This Secondary Adrenal Insufficiency can also be caused by stopping taking steroid medications for diseases like asthma or arthritis because it suppresses the natural function of the adrenal gland. Addison’s Disease occurs most often in people 30-50 years old but can occur in people of all ages. If left untreated, Addison’s Disease can be life-threatening. A person may have an emergency called Addisonian Crisis as a result of stress cause by infection, illness, or injury. The symptoms of Addison’s Disease and Addisonian Crisis are addressed in the next section.

SYMPTOMS
Weight loss, decreased appetite, fatigue, brown discoloration of skin which looks like a tan in areas not exposed to the sun (hyperpigmentation), muscle weakness, low blood pressure, fainting, nausea, vomiting, diarrhea, low blood sugar (hypoglycemia), depression, salt-craving, muscle pain, joint pain, irritability. Addisonian Crisis: severe vomiting, severe diarrhea, dehydration, low blood pressure, pain in low back, pain in abdomen, pain in legs, loss of consciousness, high potassium (hyperkalemia)

DIAGNOSIS
Diagnosis of Addison’s Disease is usually done after a thorough history and physical exam by doing a few blood tests. In the blood, the doctor checks the electrolytes (sodium and potassium), cortisol, and ACTH. If autoimmune disease (the body attacking itself) is the cause, a blood test for autoantibodies may be positive. A test called ACTH stimulation test is usually done which involves giving an injection of ACTH with measurement of the cortisol level before and after. This test can tell whether the adrenal glands respond appropriately to stimulation by ACTH. With Addison’s Disease, the adrenal glands do not respond to the stimulus appropriately. Less frequently, a test is done to see how a person’s adrenal gland responds to injection of insulin. Normally, insulin causes glucose to fall and cortisol to rise but not in Addison’s Disease. Your doctor or endocrinologist (doctor who specializes in glands and hormones) may also want to take pictures with the CT scan or MRI of both the abdomen (to see the adrenal glands) and the head (to look at the pituitary gland).

TREATMENT
Some medications to treat Addison’s Disease aim to replace hormones that the body is not naturally producing such as corticosteroids, hydrocortisone, predisone, fludrocortisone, and dehydroepiandosterone. Generally, these hormones are given by mouth in small doses daily that are similar to the body’s natural production. In times of stress, like prior to surgery or when you have an infection, the body normally makes extra stress hormones. At these times, you will likely need an extra dose of steroids to compensate. The dehydroepiandosterone may be needed if your male sex hormones are low. During an Addisonian crisis, a person may require intravenous (IV) injections of sugar (dextrose), steroids (hydrocortisone), and IV fluids like saline.

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