Addison disease

Addison disease

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Addison's disease is a condition where the adrenal glands do not produce enough hormones. In this article, we outline the symptoms.

Initial symptoms

Initial signs and symptoms include:

• fatigue
• dizziness
• lack of motivation, lack of drive
• drowsiness and lethargy
• muscle weakness
• irritability
• mild depression, changes in mood and personality
• hypovolemia - or low blood volume
• unintentional weight loss
• loss of body hair
• lack of appetite
• hypotension - low blood pressure
• difficulty in standing up
• anxiety
• diarrhea
• vomiting
• nausea
• headache
• muscle and joint pain
• craving for foods with a high salt content, due to urinary loss of sodium
• hypoglycemia - low blood sugar
• fainting
• irregular menstrual periods, in some cases periods are missed completely
• sexual dysfunction (in women)
• psychosis (very rare)

Some individuals may experience orthostatic hypotension - a sudden drop in blood pressure, especially when going from seating or lying position to standing. TYhis can cause fainting.
Another common symptom is hyperpigmentation - darkening of an area of skin or nails. In cases of Addison's disease, hyperpigmentation typically occurs in the creases of the palms of the hands, scars, knuckles, or knees.
Another illness or accident may cause symptoms to worsen suddenly.

Acute adrenal failure

Acute adrenal failure is also known as Addisonian crisis or adrenal crisis. Adrenal crisis is a medical emergency and can cause death if medical care is not sought immediately.
Sometimes the signs and symptoms of Addison's disease may appear suddenly, as may be the case with acute adrenal failure.
Signs and symptoms may include:

• psychosis, confusion, or altered mental status
• severe abdominal pain
• elecrolyte abnormalities, such as hyperkalemia - high potassium- or hyponatremia (low sodium)
• extreme muscle weakness caused by electrolyte abnormalities
• arrythmias (from hyperkalemia)
• loss of consciousness
• lethargy
• acute back or leg pain
• seizure
• clinically significant hypotension (low blood pressure) or shock, which may lead to organ damage or failure from lack of oxygen
• severe vomiting and diarrhea that may cause dehydration

An adrenal crisis may occur if the Addison's disease is left untreated, allowing levels of cortisol and aldosterone in the body to gradually drop. It may also happen if someone who has been taking steroids for a long time stops suddenly.

causes of Addison's disease

The adrenal glands, which form part of our endocrine system, are situated just above each kidney. The adrenal glands produce hormones which affect every organ and tissue in our bodies.

The adrenal glands consist of the medulla (interior) and cortex (outer layer). The medulla produces adrenaline-like hormones, while the cortex secretes corticosteroids, including glucocorticoids, mineralocorticoids and sex hormones. Glucocorticoids, which includes cortisol:

• Influence how the body converts food into energy
• Are involved in our immune system's inflammatory response
• Help the body respond to stress.

Mineralocorticoids, which includes aldosterone:

• Help regulate blood pressure
• Maintain the body's sodium and potassium (electrolyte) balance.

An autoimmune condition

Addison's disease occurs when the outer layer of the adrenal glands (adrenal cortex) is faulty or damaged. This is mainly caused by our immune system attacking it, as if it were harmful bacteria or viruses. In other words, Addison's disease may be the result of an autoimmune condition.

Our immune system is our body's defense mechanism against disease, toxins or infection. When we are ill our immune system produces antibodies which attack whatever is causing us to be ill. Some people's immune system may start attacking healthy tissue and organs - this is called an autoimmune condition/disorder.

Our adrenal glands stop producing enough steroid hormones (cortisol and aldosterone) when 90% of the adrenal cortex is destroyed. As soon as levels of these hormones start to drop, Addison's disease signs and symptoms begin to emerge.

According to The National Health Service (NHS), UK, approximately 80% of all cases of Addison's disease are caused by autoimmune conditions in industrialized nations (rich countries). Addison's disease which is the result of an autoimmune condition is sometimes known as Autoimmune Addison's Disease).

Recent studies have demonstrated that some people with specific genes are more likely to have an autoimmune condition.

The NHS states that up to 50% of patients with autoimmune Addison's disease have at least one other autoimmune disorder, such as hypothyroidism, type 1 diabetes, or vitiligo.

Tuberculosis (TB) - a bacterial infection which affects the lungs and can spread to other parts of the body. Some patients with TB have a higher risk of damage to the adrenal glands, making them more likely to develop Addison's disease.

Addison's disease may also be caused by:

• A genetic defect in which the adrenal glands do not develop properly
• A hemorrhage
• Adrenalectomy - the surgical removal of the adrenal glands
• Amyloidosis
• An infection

Addison's disease treatment

What medications are available for Addison's disease?

The drugs required to effectively treat Addison's depends on the hormones that are no longer being effectively produced in the adrenal glands.
Some potential medications include the following:

• Hydrocortisone - these tablets replace the missing cortisol. Prednisolone or dexamethasone are prescribed less commonly.
• Fludrocortisone - might be prescribed for missing aldosterone.
• Dehydroepiandrosterone (DHEA) - these pills may be prescribed if there is an androgen (the male sex hormone) deficiency.

Medication side effects

Side effects of hydrocortisone and fludrocortisone: include sleep problems, acne, slow wound healing, dizziness, nausea, and increased sweating.
Side effects of DHEA in women: similar to above but may also include changes in menstrual cycle, developing a deeper voice, and facial hair growth.
The frequency a patient has to take medication depends on their level of hormone deficiency and the severity of their symptoms. As a result, patients will have their treatment program tweaked by a healthcare professional over time.

Complications during treatment

Because the condition is treated with medications that need to be taken for the rest of a patient's life, there are several risk factors that need to be considered.
Caution must be exercised when the person with Addison's disease experiences the following:

• Illness - if the patient becomes unwell, their hormonal levels may be impacted, meaning that their medications may be less effective in alleviating symptoms.
• Surgery - a dysfunction of the adrenal gland is an important consideration during surgery; patients will need to be carefully monitored and have their treatment adjusted during and when recovering from surgery.
• Pregnancy - if a patient becomes pregnant, hormone levels change. During pregnancy, medications may have to be adjusted regularly to be effective.

During times of stress, injury, or infection medication may need to be increased. If the patient suffers from vomiting, the medications might need to be injected.