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Definition
Addison's disease is a rare disorder of the adrenal glands. In the case of Addision's, the glands do not produce enough of the hormones cortisol and aldosterone.
Adrenal Glands
Addison's occurs because of damage to the cortex.
2008 Nucleus Medical Art, Inc.
Causes
Addison's disease is the result of gradual damage to the adrenal cortex, the outer layer of the adrenal gland. This damage may be caused by:
- The body's immune system attacking the gland (autoimmune disease), which accounts for 85% of cases in developed countries
- Tuberculosis (major cause in the Third World countries)
- Bleeding within the adrenal glands (related to use of anticoagulant medications and shock)
- Surgical complication
- Congenital (present at birth) or genetic factors (enzyme defects, familial glucocorticoid insufficiency)
- Cytomegalovirus (CMV) associated with AIDS
- Fungal infections, including:
- Blastomycosis
- Histoplasmosis
- Coccidioidomycosis
- Cancer including metastases from:
- Long-term corticosteroid treatment
- Medications (such as ketoconazole or etomidate)
- Radiation treatment
- Chronic illness, including:
- Sarcoidosis
- Hemachromatosis
- Amyloidosis
- Adrenoleukodystrophy
- Adrenomyelodystrophy
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include: Having the following autoimmune diseases can put you at risk for an associated autoimmune-based Addisons disease: Type I diabetes Pernicious anemiaHypoparathyroidismHypopituitarismGonadal collapseHyperthyroidism (Graves disease) or hypothyroidism (Hashimotos disease)Myasthenia gravisStressAnticoagulant medicationsAbdominal injuryFamily members with autoimmune-caused Addison's disease Long-term steroid medication treatment, followed by: Severe stressInfectionSurgeryTraumaPrevious surgery on adrenal glands Symptoms Symptoms may include: Extreme weakness, fatigueWeight lossNausea or vomiting Chronic diarrheaMuscle weaknessDarkening of freckles, nipples, scars, skin creases, gums, mouth, nail beds, and vaginal lining Emotional changes, especially depressionCraving for salty foodsAbdominal painAnorexiaAmenorrhea A severe complication of Addison's disease is the Addisonian or adrenal crisis. Symptoms include: Severe abdominal, back, or leg painFainting or semicomatose stateSevere low blood pressureSevere dehydrationSevere nausea, vomiting, and diarrheaLow blood sugarGeneralized muscle weakness DiagnosisThe doctor will ask about your symptoms and medical history. A physical exam will be performed.
Tests may include: Blood and urine teststo see if you have low levels of cortisol and aldosterone, high level of ACTH (ACTH is a hormone that stimulates the adrenal glands), and to measure levels of: Anti-adrenal antibodySodiumChlorideCalciumPotassiumBicarbonateBlood urea nitrogen levelsACTH stimulation testmeasures cortisol in the blood and/or urine before and after an injection of ACTHX-rayspictures of the abdomen to see if the adrenal glands have signs of calcium deposits CT scan of the abdomena type of x-ray that uses a computer to make pictures of structures inside the body, in this case the adrenal glands TreatmentSymptoms of Addison's disease can be controlled with medications. These drugs can replace the missing hormones. Medication needs to be taken for the rest of your life. They may be increased in times of stress. Medications may include: Cortisone acetateHydrocortisone tabletsFludrocortisone acetate (Florinef) Immediate treatment of adrenal crisis includes: HydrocortisoneSalt waterSugar MaintenanceRegular blood tests are needed to monitor your response to medication. Wear a medical alert bracelet in case of an emergency. PreventionThere are no guidelines for preventing Addison's disease. If you think you are at risk, talk to your doctor.
RESOURCES: American Academy of Family Physicianshttp://familydoctor.org/ National Institute of Diabetes and Digestive and Kidney Diseaseshttp://www.niddk.nih.gov/ CANADIAN RESOURCES: BC Health Guidehttp://www.bchealthguide.org/ Canadian Addison Societyhttp://www.addisonsociety.ca/ References: Addison's disease. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health/endo/pubs/addison/addison.htm. Accessed June 13, 2008. Arlt W, Allolio B. Adrenal insufficiency. Lancet. 2003 May 31;361(9372):1881-1893. Dorin RI, Qualls CR, Crapo LM. Diagnosis of adrenal insufficiency. Ann Int Med. 2003;138:3:194-214. Salvatori R. Adrenal Insufficiency. JAMA. 2005;294:2481-2488. Ten S, New M, Maclaren N. Clinical Review 130: Addison's disease. J Clin Endo Metabol. 2001;86:2909-2922. Thomas Z, Fraser GL. An update on the diagnosis of adrenal insufficiency and the use of corticotherapy in critical illness. Ann Pharmather. 2007;41:1456-65. Last reviewed October 2007 by David Juan, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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