Addison’s Disease

Addison's disease is also known as primary adrenal insufficiency or hypoadrenalism. It is a rare disorder of the adrenal glands. It mainly affects the production of two hormones that is cortisol and aldosterone. Cortisol is usually released in conditions of stress, it helps to maintain energy levels, blood sugar levels, and carbohydrate metabolism. Aldosterone maintains the salt and water balance in the body, which helps to control blood pressure.

Addison’s disease is characterized by progressive anemia, low blood pressure, weakness, and bronze discoloration of the skin because of the inadequate production of hormones cortisol and aldosterone. It affects all age groups but is more common in the age group of 30 to 50yrs. Both males and females are equally affected.

The disease is a slow process, in which symptoms appear late but one should be careful in diagnosing this it can cause Addison’s crisis which develops in response to the body’s stress such as in conditions like injury, infection, or illness. Addison’s crisis is the condition in which adrenaline failure leads to shock associated with severe weakness, nausea, vomiting, severe pain in the abdomen, confusion, decreased consciousness, and low blood pressure. It is a life-threatening condition and hence should be treated early. The treatment is mainly done by replacing the hormones.

Addison’s Disease Causes

Primary causes for adrenal deficiency include

• It is an autoimmune disease, in which the body’s immune system mistakes any organ or area of the body for a virus, bacteria, or another outside invader.

• Prolonged administration of glucocorticoids such as prednisone

• Infections in the body such as tuberculosis

• Bleeding in the adrenal glands

• Cancer and abnormal growths

• Patients taking blood thinners used to control clotting in the blood

Secondary causes of adrenal deficiency include −

• Tumors

• Medications

• Genetics

• Traumatic brain injury

Addison’s Disease Symptoms

The main symptoms of Addison’s disease are because of the less or absent production of the hormone’s glucocorticoids and mineralocorticoids. Hence it presents with the following symptoms −

• Weakness and tiredness

• Weight loss and decreased appetite

• Darkening of their skin (hyperpigmentation)

• Low blood pressure, because of which the patient has often felt giddy

• Decreased heart rate

• Craving for salt

• Low blood sugar

• Gastrointestinal symptoms like nausea, diarrhea, or vomiting

• Pain in the abdomen

• Muscle or joint pains

• Irritability

• Depression or other behavioral symptoms

• Body hair loss or sexual dysfunction in women

• Ulcers in the mouth

• Neuropsychiatric symptoms like irritability, depression, and sleep disturbances

• Adrenaline crisis presents with low blood pressure, agitation, delirium, and visual and auditory hallucinations, high fever, sudden severe pain in the lower abdomen.

Addison’s Disease Risk Factors

Some of the risk factors which increase the risk of Addison’s disease are −

• Cancer

• Patients taking blood thinners

• Patients having chronic infections like tuberculosis

• Patients who underwent surgery to remove any part of the adrenal gland

• Patients having autoimmune diseases, like type 1 diabetes or Graves’ disease

Addison’s Disease Diagnosis

The diagnosis of Addison’s disease is based on the clinical presentation and some of the investigations.

• Complete history collection and physical examination − Physical examination must be done. Dark patches on the skin give a clue to consider testing for Addison’s disease.

• Serum electrolyte levels − Shows increased levels of potassium and decreased levels of sodium

• Blood tests − These are done to measure the levels of sodium, potassium, cortisol, and ACTH in the blood.

• ACTH stimulation test − In these tests, the adrenal glands’ response after giving a shot of artificial ACTH is seen. If the adrenal glands produce low levels of cortisol after the shot, they may not be functioning properly.

• X-rays − Done to look for calcium deposits on the adrenal glands.

• Computed tomography (CT scan) − CT scan is done to evaluate the adrenals and/or pituitary gland. It can show any damage to the adrenal glands by the immune system and also shows signs of infection if the glands are infected.

Addison’s Disease Treatment

The main treatment of Addison’s disease includes −

• Replacement of the cortisol by giving Hydrocortisone pills

• If the patient has lesser aldosterone, then fludrocortisone acetate pills should be given. If patients are taking fludrocortisone acetate, they need to increase salt intake, especially in hot and humid weather and after exercise. In emergencies and during surgery, the medicine is given intravenously

• Monitor BP and weight

• Every 2hr postprandial glucose test should be performed

• Sodium chloride is given intravenously to increase sodium levels

• Insulin is given if necessary

• Ant-vomiting injection as tolerated by the patient

• Provide high-calorie snacks and finger foods

• Daily weight should be checked

• Patient should be monitored frequently for dysrhythmias

• Nutritional supplements

Addison’s Disease Prevention

There are no methods found to prevent Addison’s disease. But Addison’s crisis should be prevented by early diagnosis of the condition and treating it when a patient presents with minimal symptoms.

Conclusion

Addison’s disease is a rare but severe condition affecting all age group people. In this, the adrenal gland fails to produce enough hormones mainly cortisol and aldosterone. These hormones are required for the body to handle stress and maintain blood pressure. Hence when these are produced in fewer amounts it presents various symptoms. It is mainly an autoimmune disease in which the body’s immune system reacts against its own tissue. It can also be caused by infections, and tumors affecting the adrenal gland.

The patient present with various symptoms mentioned above. The symptoms develop over a longer duration. If the condition is left untreated for a longer duration the patient goes into Addison’s crisis which is life-threatening. Hence it should be prevented by on-time treatment with supplementing of the hormones. Hydrocortisone is given to replace the cortisol and fludrocortisone acetate is given to replace the aldosterone levels.