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Addison’s Disease
Addison’s disease is a rare condition. It is a chronic disease that causes the adrenal glands to not produce enough hormones. The two hormones that Addison’s disease impacts are cortisol and aldosterone.
Cortisol is a hormone that is sometimes known as the stress hormone. It helps your body respond to illness, injury, surgery, maintain blood pressure, heart function, immune system, and glucose levels. Cortisol is vitally important.
Aldosterone is a hormone that helps regulate sodium and potassium levels in the blood.
The adrenal glands are part of the endocrine system and are located above the kidneys. Addison’s disease occurs when there is damage to the adrenal cortex. This is usually caused by an autoimmune response.
Addison’s disease is different from Cushing’s disease, because Addison’s disease produces too little amounts of cortisol. In Cushing’s disease the adrenal glands produce too much cortisol.
Risk Factors
Anyone can have Addison’s disease. It is more common in people who range from 30-50 years old. You are at a higher risk of Addison’s disease if you also suffer from type 1 diabetes, pernicious anemia, Grave’s disease, chronic thyroiditis, dermatitis herpetiformis, vitiligo, or myasthenia gravis.
Symptoms
Symptoms for Addison’s disease start slowly and develop over the course of a few months. The progression of the disease can be extremely slow. Which can cause someone to ignore the symptoms at first. Injury or illness can cause the symptoms to worsen more quickly.
The main symptoms of Addison’s disease are muscle weakness, fatigue, tiredness, darkening in skin, weight loss, decreased appetite, low heart rate, low blood pressure, low blood sugar, fainting spells, sores in mouth, cravings for salt, nausea, and vomiting.
Long term patients with Addison’s disease may develop some neuropsychiatric symptoms such as irritability, depression, lack of energy, or sleep disturbances. If left untreated symptoms can include agitation, delirium, or visual and auditory hallucinations.
Addison’s disease can become life threatening, if any of these symptoms are present, change in mental status, loss of consciousness, high fever, sudden pain in the lower back, belly, or legs it is important to get medical help right away. If Addison’s disease is left untreated for too long it can result in shock and death.
Diagnosis
Since symptoms are so slow to progress and appear it can take some time for a diagnosis to occur. Sometimes a diagnosis may be caught accidentally. A routine basic metabolic panel can show low sodium levels and high potassium levels which can be a sign of Addison’s disease. Another first clue that may queue your doctor into testing for Addison’s disease are the dark skin patches that may appear as a symptom.
In diagnosing Addison’s disease blood tests will be done to check the levels of sodium, potassium, cortisol, and ACTH in the blood. ACTH is a hormone that is responsible for cortisol production. An ACTH stimulation test can also be done. This test is designed to see what the adrenal glands’ response is to an injection of ACTH. If there are low levels of cortisol after the injection, the adrenal glands may not be functioning appropriately.
Another test that can be done is the Insulin-induced hypoglycemia test. In this test the blood sugar levels are checked after an injection of fast acting insulin. The doctor will be looking for low blood sugar levels and high cortisol levels. If not it can also be an indicator of Addison’s disease.
A CT scan can also be done to look at the adrenal glands. A CT scan will show if there is damage to the glands or if the glands are infected.
Treatment
Addison’s disease is a chronic condition. There is no cure. Treatment is lifelong. Treatment will be a plan of medications that is specific to you. No two people respond to medications the same, so making sure you are taking the right amount and the right dosage every day without skipping a dose is important to the treatment of Addison’s disease.
Medications you may be given are hydrocortisone which is a medication that helps replace cortisol. Fludrocortisone is a medication that replaces aldosterone. Along with those hormone replacement medications you may also need to take glucocorticoids which help stop inflammation in the body.
These medications will most likely be lifelong, and it is important to not miss a dose. At home it is important to have an emergency kit with all your medications in it. You can also ask your doctor for an injectable corticosteroid in case of emergencies.
Outcomes
If Addison’s disease is left untreated for a long time you can develop Addison’s crisis. This complication can be life threatening. Addison’s crisis can cause low blood sugar, high potassium, and low blood pressure.
As long as the treatment plan is followed, and you are appropriately diagnosed without leaving this condition left untreated, you can live a normal quality of life. Making sure to have follow up exams with your doctor in case of any medication changes is also important.
Cravings for salt and fainting are two signs your adrenal glands are not working properly. Learn more about Addison's Disease! #HealthSurgeon
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