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Addisons Disease Overview
Addison's disease is a disease of the adrenal glands. The adrenal glands normally produce mineralocorticoids and glucocorticoids-hormones specific to the adrenal glands. These hormones are produced in the cortex or outer portion of the adrenal glands and, when reduced, become the cause of Addison's disease.
The adrenal glands are two glands that are located atop the kidneys. They consist of a cortex or outer portion and a medulla or inner portion. The medullary portion of the adrenal gland produces norepinephrine and epinephrine, which are not involved in Addison's disease. Glucocorticoids help maintain the sugar control of the body and reduce the immune response. They help the body respond to stress, which can be physical or emotional. Mineralocorticoid hormones include aldosterone, which regulates the balance of sodium and potassium of the body. Sex hormones are also produced in the medullary portion of the adrenal gland.
Damage to the adrenal gland's cortex can result from an infection, such as HIV, tuberculosis, or fungal infections. There can be an autoimmune response that affects the cortex of the adrenal gland and hemorrhage or blood loss can cause adrenal damage. Tumors can diminish the function of the adrenal gland and you can get damaged adrenal cortex from blood thinners.
Risk factors for getting autoimmune diseases include having dermatitis herpetiformis, chronic thyroiditis, hypo-parathyroidism, hypopituitarism, testicular problems, myasthenia gravis, type I diabetes, vitiligo, and pernicious anemia. These are mostly autoimmune diseases that can have Addison's disease as a secondary factor.
Symptoms of Addison's disease include chronic diarrhoea, heart rate changes, blood pressure reduction, darker skin, pale skin, weakness of the body, fatigue, mouth lesions, loss of appetite, craving salt, nausea or vomiting, and moving too slowly or sluggishly. You can have an unintentional weight loss as a result of Addison's disease.
Tests for Addison's disease include several blood tests. They include having a high potassium level, a low blood pressure, a low body cortisol level, a low sodium level in the bloodstream and a normal sex hormone level. Abdominal x-rays can show a tumor on the adrenal gland but an abdominal CT scan is considered a better test for Addison's disease. Specific tests for Addison's disease include 17-hydroxycorticosteroids, a 24 hour urinary aldosterone excretion, 17 ketosteroids, ACTH level, eosinophil count, aldosterone level, CO2 level, potassium test, renin level, and cortrosyn stimulation test. Sometimes a urine cortisol level is checked at specific times of the day.
Treatment of Addison's disease involves giving back the missing corticosteroids to control the symptoms of the syndrome. Mineralocorticoids are also given in the form of fludrocortisone. The medications need to be given for the live of the individual and don't actually cure the disease. If you skip taking a dose or two of the medication, you can have life threatening complications.
The medication is increased whenever you have an infection, stress or injury, which is what the body would naturally do during these times.
An adrenal crisis occurs when there is a sudden drop in cortisol levels and is life threatening. You need an immediate dose of corticosteroids to bring your blood pressure up and normalize your hormone levels. You can give yourself an emergency injection of corticosteroids whenever you feel the onset of a stressor or adrenal crisis coming on. You should wear a medic alert bracelet or necklace so healthcare providers know what to do in case of an emergency, should you become unconscious or unable to speak.
The prognosis of Addison's disease is good if you continue taking the hormone replacement medications. Complications are possible, including the onset of diabetes, hypoparathyroidism, testicular or ovarian failure, Hashimoto's thyroiditis, pernicious anaemia, and thyrotoxicosis.
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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here