Addison's disease

Addison's disease

What is Addison's disease?

Addison's disease occurs when the two adrenal glands in the body are damaged and are no longer able to produce certain hormones, which are essential for the maintenance of life. The adrenal glands are situated on top of each kidney.

'The adrenal glands sit like a small cap on the upper pole of each kidney.'

They produce three different groups of hormones known as corticosteroids. One group consists of the androgens and estrogens, which affect sexual development and reproduction. The glucocorticoids maintain glucose regulation, suppress the body's antibody response and provide for the response to stress through the secretion of cortisol. The third group are known as mineralocorticoids and they regulate sodium and potassium balance in the body.

What causes it?

Addison's disease is quite rare, but by far the most common cause of it is an autoimmune disorder in which the body's own immune system attacks and destroys the adrenal glands. Sudden withdrawal of long term steroid therapy, removal or injury of the adrenal glands or destruction of the pituitary gland may also cause it. The disease can also be triggered by factors such as infection, cancer or bleeding into the adrenal glands.

What are the symptoms?

In most cases, the symptoms of Addison's disease come on gradually. Any or all of the following symptoms may be present:

  • a general feeling of weakness and fatigue.
  • darkening of the skin.
  • unexplained weight loss.
  • low blood pressure, leading to frequent dizzy spells.
  • an imbalance of salt in the body, leading to irregular beating of the heart.
  • pains in the muscles and joints.
  • nausea, vomiting and diarrhoea.
  • pain in the flank.

If the condition comes on abruptly the patient's general condition can deteriorate rapidly leading to very low blood pressure, dehydration, high fever, profound weakness, excessive sweating ultimately leading on to loss of consciousness and death. This scenario is called an Addisonian Crisis and must be dealt with as an extreme emergency.

How is it diagnosed?

Addison's disease may be suspected on the basis of the symptoms and physical findings however the following laboratory findings are diagnostic of the condition:

  • cortisol level is low.
  • fasting blood sugar may be low.
  • serum potassium is elevated.
  • serum sodium is decreased.

How is it treated?

Addison's disease is usually treated by the replacement of the missing adrenal hormones. In the short-term this may involve the use of IV fluids, IV hormones and other medications to stabilise the patient's general condition. Once the patient is stable hormone pills alone can be used to treat the disease. Life long hormone replacement will be required and regular blood tests will be necessary to monitor salt and hormone levels in the body.

All patients with Addison's disease are instructed in the adjustment of their drug treatment if they develop infection or are subjected to extreme stress. Such situations could trigger an Addisonian crisis and lead to sudden collapse if not anticipated. All patients with the condition are advised to wear a medic alert bracelet.

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