Addison's disease, also called adrenal insufficiency, adrenal crises or Addisonian crisis is an uncommon disorder that occurs when your body doesn't produce enough adrenal hormones. In Addison's disease, your adrenal glands, located just above your kidneys, produce too little cortisol and often too little aldosterone. Addison's disease occurs in all age groups and both sexes and can be life-threatening.
Addison's disease symptoms usually develop slowly, often over several months. Often, the disease progresses so slowly that symptoms are ignored until a stress, such as illness or injury, occurs and makes symptoms worse. Signs and symptoms may include:
• Extreme fatigue
• Weight loss and decreased appetite
• Darkening of your skin (hyperpigmentation)
• Low blood pressure, even fainting
• Salt craving
• Low blood sugar (hypoglycemia)
• Nausea, vomiting and diarrhea, leading to dehydration (gastrointestinal symptoms)
• Abdominal pain, muscle or joint pain or pain in lower back or legs
• Depression, mental imbalance or other behavioral symptoms
• Body hair loss or sexual dysfunction in women
• High potassium (hyperkalemia) and low sodium (hyponatremia)
• AIDs or also called autoimmune disease in which immune system suddenly attacks the adrenal glands.
• Use of glucocorticoids such as prednisone
• Infections like viral and fungal infections
• Bleeding in adrenal glands
• If adrenal gland is operated through surgery
• Damage of adrenal gland by not producing enough hormone cortisol and aldosterone
• Infection in the body
• Cancer or tumors
• Lack of adrenocorticotropic hormone
• Brain injuries
1. Primary Adrenal Insufficiency
When the cortex is damaged and doesn't produce enough adrenocortical hormones, the condition is called primary adrenal insufficiency. This is most commonly the result of the body attacking itself (autoimmune disease).
For unknown reasons, your immune system views the adrenal cortex as foreign, something to attack and destroy. People with Addison's disease are more likely than others to have another autoimmune disease as well.
2. Secondary Adrenal Insufficiency
The pituitary gland, which is the master gland of the body, gives order to the adrenal cortex to secrete glucocorticoids and androgens. If, due to some reason e.g., brain injury or pituitary tumors or surgeries, the pituitary gland gets damaged, it will not produce or produce too little hormone. As a result, the adrenal cortex will also produce too little or not produce not at all the glucocorticoids and androgens This is called secondary adrenal insufficiency.
Most symptoms of secondary adrenal insufficiency are like those of primary adrenal insufficiency. However, people with secondary adrenal insufficiency don't have hyperpigmentation and are less likely to have severe dehydration or low blood pressure. They're more likely to have low blood sugar.
A temporary cause of secondary adrenal insufficiency occurs when people who take corticosteroids (for example, prednisone) to treat chronic conditions, such as asthma or arthritis, stop taking the corticosteroids all at once rather than tapering off.
Your doctor will talk to you first about your medical history and your signs and symptoms. You may undergo some of the following tests:
• Blood test: Tests can measure your blood levels of sodium, potassium, cortisol and adrenocorticotropic hormone (ACTH), which stimulates the adrenal cortex to produce its hormones. A blood test can also measure antibodies associated with autoimmune Addison's disease.
• ACTH Stimulation Test: ACTH signals your adrenal glands to produce cortisol. This test measures the level of cortisol in your blood before and after an injection of synthetic ACTH.
• Insulin-induced Hypoglycemia Test: You may be given this test if doctors think you may have adrenal insufficiency as a result of pituitary disease (secondary adrenal insufficiency). The test involves checking your blood sugar (blood glucose) and cortisol levels after an injection of insulin. In healthy people, glucose levels fall, and cortisol levels increase.
• Imaging Tests: You may undergo a computerized tomography (CT) scan of your abdomen to check the size of your adrenal glands and look for other abnormalities. You may also undergo an MRI scan of your pituitary gland if testing indicates you might have secondary adrenal insufficiency.
• In certain situations, doctors may do alternative tests for secondary adrenal insufficiency, such as a low-dose ACTH stimulation test, prolonged ACTH stimulation test or glucagon stimulation test.
All treatment for Addison's disease involves medication. You will be given hormone replacement therapy to correct the levels of steroid hormones your body isn't producing. It typically includes intravenous injections of Corticosteroids (hydrocortisone).
Other treatment recommendations include:
• Rehydrating the patient.
• Saline solution for balancing their electrolyte levels.
• Sugar (dextrose) for normalizing blood sugar level and blood pressure.
• Oral Corticosteroids such as Hydrocortisone, prednisone or methylprednisolone and Fludrocortisone acetate
• Intake of plenty of salts in diet, especially during heavy exercise, when the weather is hot or if you have gastrointestinal upsets, such as diarrhea.
• Your doctor will also suggest a temporary increase in your medication dosage if your body is stressed, such as from an operation, an infection or a minor illness. If you're ill with vomiting and can't keep down oral medications, you may need injections of corticosteroids.
Things to take care of, if you suffer from Addison's Disease:
• Always carry a medical alert card and bracelet. A steroid emergency card and medical alert identification will let emergency medical personnel know what kind of care you need. Also have a written action plan.
• Keep extra medication handy. Missing even one day of medication may be dangerous, so keep a small supply of medication at work and with you whenever you travel.
• Carry a glucocorticoid injection kit. The kit contains a needle, syringe and injectable form of corticosteroids to use in case of emergency.
• Stay in contact with your doctor. Keep an ongoing relationship with your doctor to make sure that the doses of replacement hormones are adequate, but not excessive. If you're having ongoing problems with your medications, you may need adjustments in the doses or timing of the medications.
• Have annual check-ups. See your doctor or an endocrinology specialist at least once a year. Your doctor may recommend annual screening for several autoimmune diseases.