Addison’s disease or adrenal insufficiency is a chronic hormonal insufficiency disease. Read about Addison’s disease symptoms and treatment at Meri Sehat.

Addison’s Disease

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Iqra Mazhar

Overview

<p>Addison&rsquo;s disease is also known as chronic adrenocortical infection, primary adrenal insufficiency, and primary failure adrenocortical insufficiency. The condition is characterized by the failure of adrenal glands due to an autoimmune attack. This causes deficiency of the cortisol and aldosterone hormones<sup><a href="#accordion">[1]</a></sup>.&nbsp;</p>

<p>&nbsp;</p>

<p>Addison&rsquo;s disease is a rare autoimmune dysfunction. The disease is named after Thomas Addison, an English physician.&nbsp;In 1849, he wrote a short article titled &lsquo;Anemia &ndash; disease of the suprarenal capsules in which the disease is not distinctly separated from a new form of anemia.&rsquo; This was followed by his monograph in 1855, which mentioned 2 undistinguished chronic diseases. Later, Trousseau confirmed it as a suprarenal failure and referred to the disease as Addison&#39;s disease<sup><a href="#accordion">[2]</a></sup>.</p>

<p>Addison&rsquo;s disease cases seldom appear. There is no impact of gender on the prevalence of the disease. In the US, only 1 in 100,000 people are found to have Addison&rsquo;s disease. The ratio is similar across multiple countries, hence, the same can be considered for Pakistan as well. The main issue lies in the underreporting and underdiagnosis of the cases, which always leave some space for uncertainty in terms of estimating the true prevalence of the disease<sup><a href="#accordion">[3]</a></sup>.</p>

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<p>Adrenal insufficiency consists of the following the 3 types<sup><a href="#accordion">[4][5]</a></sup>:</p>

<p>&nbsp;</p>

<ul>
	<li><strong>Primary Adrenal Insufficiency:</strong> This is Addison&rsquo;s disease where the adrenal gland fails to make enough cortisol and aldosterone. The disease is relatively rare and can affect anyone.</li>
</ul>

<p>&nbsp;</p>

<ul>
	<li><strong>Secondary Adrenal Insufficiency:</strong> It is characterized by the inability of the pituitary gland to make enough adrenocorticotropin. This, in turn, causes the adrenal glands to produce insufficient cortisol.</li>
</ul>

<p>&nbsp;</p>

<ul>
	<li><strong>Tertiary Adrenal Insufficiency:</strong> This type of insufficiency originates in the hypothalamus. The corticotropin-releasing hormone is released by the hypothalamus. In the disease, the hypothalamus is unable to release the hormone, which affects the pituitary gland&rsquo;s ability to make adrenocorticotropic hormone (ACTH). Consequently, it stops the production of cortisol from the adrenal glands.</li>
</ul>

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Signs And Symptoms

<p>Signs and symptoms of Addison&rsquo;s disease include:</p>

<ul>
	<li>Chronic fatigue</li>
	<li>Muscle weakness</li>
	<li>Abdominal pain</li>
	<li>Weight loss</li>
	<li>Loss of appetite</li>
	<li>Nausea</li>
	<li>Vomiting</li>
	<li>Diarrhea&nbsp;</li>
	<li>Joint pain</li>
	<li>Hypoglycemia</li>
	<li>Lowered libido</li>
	<li>Amenorrhea or eumenorrhea&nbsp;</li>
	<li>Irritability&nbsp;</li>
	<li>Depression&nbsp;</li>
	<li>Low blood pressure</li>
	<li>Hyperpigmentation</li>
</ul>

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Causes

<p>The core reason for the deficiency in cortisol and aldosterone is adrenal insufficiency. Adrenal insufficiency is caused due to different reasons depending on its type.&nbsp;</p>

<p>Addison&rsquo;s disease refers to primary adrenal insufficiency. This is an autoimmune disease, i.e., the immune system starts attacking the patient&rsquo;s own body. Almost all individuals who have Addison&rsquo;s disease have autoimmune causes behind them<sup><a href="#accordion">[6]</a></sup>.&nbsp;</p>

<p>However, infections like tuberculosis or patients with <a href="https://merisehat.pk/disease/hiv" target="_blank">HIV</a>/<a href="https://www.merisehat.pk/disease/aids" target="_blank">AIDS </a>are also highly prone to developing Addison&rsquo;s disease since these conditions can damage adrenal glands<sup><a href="#accordion">[7]</a></sup>.&nbsp;Some other causes of Addison&rsquo;s disease include:&nbsp;</p>

<p>&nbsp;</p>

<ul>
	<li>Fungal infections</li>
	<li>Cancer cells in other parts of the body</li>
	<li>Cytomegalovirus&nbsp;</li>
	<li>Surgical removal of adrenal glands</li>
	<li>Genetic disorders</li>
</ul>

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Diagnosis

<p>The diagnosis starts with the physician asking the patient about their symptoms and taking their medical history, particularly about the history of autoimmune disorders. Then, they would check the hyperpigmentation on the patient&rsquo;s body, especially on elbows, palms, lips, and gums.&nbsp;</p>

<p>Since the disease is so rare, it is never the first hypothesis, hence, the patient is also tested for their blood pressure in case of postural or orthostatic hypotension<sup><a href="#accordion">[8]</a></sup>.&nbsp;</p>

<p>After a complete physical examination, a blood test is ordered. The test includes checking the levels of sodium and potassium.&nbsp;ACTH stimulation test is also recommended. It measures the levels of cortisol in the blood and is carried out by injecting adrenocorticotropic hormone (ACTH) into the body to stimulate the production of cortisol. After the injection of ACTH, if the body is unable to initiate cortisol production, it means that the adrenal glands are not functioning properly. This test is also known as the Synacthen stimulation test<sup><a href="#accordion">[10]</a></sup>.&nbsp;</p>

<p>A CT scan can also aid in the examination of the adrenal glands, their size, and any possible calcification. Additionally, the physician may order an insulin-induced hypoglycemia test to see if the issues associated with the adrenal gland have anything to do with the pituitary gland. Thyroid tests are also done to determine if the patient has an underactive thyroid or hypothyroidism<sup><a href="#accordion">[9]</a></sup>.</p>

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<h4><b>"Addison’s disease can also lead to hypertension. Check out our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan </a>to get your blood pressure reading today!"<br><br></b></h4>

Treatment

<p>The treatment of Addison&rsquo;s disease is highly dependent on the type of symptoms that are experienced by the patient. The main target of the treatment involves replacing the main deficient hormones, i.e., cortisol and aldosterone. Hydrocortisone, prednisone, or methylprednisolone drugs are used for cortisol replacement, whereas fludrocortisone acetate is used for aldosterone. These hormonal therapy drugs require the patient to increase their sodium intake, especially if heavy exercise is being undertaken or diarrhea is being experienced.</p>

<p>In some cases, an investigational therapeutic approach is taken where the patients are administered with replacement drugs, like androstenedione or testosterone. This has been associated with improved mood in many people along with increased sex drive<sup><a href="#accordion">[3]</a></sup>.&nbsp;&nbsp;</p>

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<p>Patients of Addison&rsquo;s disease often face the following complications:</p>

<ul>
	<li>Shock</li>
	<li>Seizure</li>
	<li>Coma</li>
</ul>

<p>&nbsp;</p>

<h5><strong>Addisonian Crisis</strong></h5>

<p>Addisonian crisis refers to a life-threatening situation that is characterized by the worsened symptoms of Addison&rsquo;s disease<sup><a href="#accordion">[10]</a></sup>. This includes low blood sugar levels, high blood potassium levels, and low blood pressure.&nbsp;</p>

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<p>Addison&rsquo;s disease can happen to anyone. However, people with the following issues are more prone to developing the disease<sup><a href="#accordion">[11][12]</a></sup>:</p>

<ul>
	<li><a href="https://www.merisehat.pk/disease/diabetes-type-1-and-2" target="_blank">Type I diabetes</a></li>
	<li>Hypopituitarism</li>
	<li>Hypoparathyroidism</li>
	<li>Grave&rsquo;s disease</li>
	<li>Pernicious <a href="https://www.merisehat.pk/disease/anemia" target="_blank">anemia</a></li>
	<li>Vitiligo</li>
	<li>Dermatitis herpetiformis</li>
	<li>Chronic thyroiditis</li>
	<li>Testicular failure</li>
	<li>Myasthenia gravis</li>
	<li>Other rare genetic insufficiency&nbsp;</li>
</ul>

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<p>While there is no way to prevent autoimmune diseases, there are secondary prevention methods to help patients with Addison&rsquo;s avoid an Addisonian crisis. For instance:&nbsp;</p>

<ul>
	<li>Ensuring the patient carries an identification card at all times so that in case of emergency it would inform others that they have Addison&rsquo;s disease and need help.</li>
	<li>Keeping an injectable form of cortisol along with any new needle instrument to help administer it in case of any stress in upper respiratory tract infections.</li>
	<li>Getting immediate medical attention for the patients who have experienced severe vomiting or diarrhea.&nbsp;</li>
</ul>

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Key Points

<ul>
	<li>It is a rare autoimmune disorder that involves the deficiency of the hormone aldosterone and cortisol.</li>
	<li>The lowered levels of hormones are directly connected with decreased ability of the adrenal glands.</li>
	<li>It is also called chronic adrenocortical infection or primary adrenal insufficiency.</li>
	<li>The symptoms include chronic fatigue, diminished sex drive, nausea, and vomiting.</li>
	<li>The diagnosis is done via blood tests and some other hormone derived tests to confirm not just the disease itself but also its possible causes or origins.</li>
	<li>Addisonian crisis is a common complication of the disease, which involves low blood sugar, low blood pressure and high blood potassium levels.&nbsp;</li>
	<li>The disease itself cannot be prevented but once diagnosed there are several measures that stop the symptoms from worsening. This involves keeping injectable cortisol and keeping medical help on speed dial.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;</li>
</ul>

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