Important Answers about Addison’s Disease
- Addison’s Disease Overview
- Addison’s Disease Causes
- The Symptoms and Signs of Addison’s Disease
- Diagnosing Addison’s Disease
- Treating Addison’s Disease
- Treatment and Prognosis Complications
- Adrenal Crisis Prevention and Management
Addison’s Disease Overview
Addison’s Disease is an adrenal insufficiency condition involving the adrenal glands that produce many of the body’s hormones required for normal functioning. The autoimmune disease is the result of a damaged adrenal cortex that alters the production of androgens (sex hormones) or the adrenal glands that produce insufficient amounts of cortisol and aldosterone steroid hormones. The cortisol hormone regulates how the body reacts to a stressful situation, whereas aldosterone regulates sodium and potassium levels in the body.
Addison’s Disease Causes
Addison’s disease is classified into major categories including primary adrenal insufficiency and secondary adrenal insufficiency. The causes of the type of Addison’s disease will determine the effective treatment.
- Primary Adrenal Insufficiency – This type of insufficiency is the usually the result of severely damaged adrenal glands that no longer have the capacity to produce hormones. Typically, this disease occurs when the body’s immune system no longer provide protection to the adrenal glands, but instead attacks them. Like all autoimmune diseases, primary adrenal insufficiency causes the immune system to mistakenly identify an organ or body part for an outside invader like a bacteria or virus. Common causes of Addison’s disease primary adrenal insufficiency can include:
- Abnormal growths including cancer
- Extended levels of glucocorticoids
- Some blood clot control blood thinners
- Secondary Adrenal Insufficiency – This type of Addison’s disease insufficiency is a result of a malfunctioning pituitary gland in the brain that no longer has the capacity to produce ACTH (adrenocorticotropic hormone), which manages the release of hormones from the adrenal gland. Some individuals develop secondary adrenal insufficiency if they fail to take a prescribed corticosteroid medication to control asthma or other chronic health conditions.
Less common causes can include:
- Drug interference or reaction with the body’s hormone production involving anesthetic the medications and anti-fungal drugs
- Adrenal gland cancer cells
- Adrenal gland removal through surgical procedures
- Genetic defect that could involve abnormal development, defective hormone production or the adrenal glands inability to recognize pituitary-producing adrenocorticotropic hormone (ACTH).
The Symptoms and Signs of Addison’s Disease
Many of the indicators of Addison’s disease develop slowly. Often, the individual will attribute symptoms to other factors of daily living activities including a failure to exercise or working too hard. Many early indicators are not detected until the individual has a surgical procedure, suffers another illness, becomes pregnant or experiences an accidental trigger that worsens the disease’s symptoms.
Common adrenal insufficiency symptoms include:
- Chronic and extreme fatigue
- Decreased appetite and weight loss
- Abdominal pain
- Muscle weakness
- Muscle or joint pain
- Loss of appetite
- Darkening of the skin
- Low blood sugar (hypoglycemia)
- Salty food craving
- Loss of body hair
- Vomiting, diarrhea or nausea
- Nonexistent or irregular menstrual periods
- Hypoactive Sexual Desire Disorder (HSDD) – loss of sexual desire
Adrenal crisis can develop when there is a severe, sudden worsening of one or more symptoms. The crisis can become start without warning but is often the result of extremely low cortisol levels. When severe symptoms occur, it is crucial to seek immediate emergency care to avoid an adrenal crisis that could lead to death. Common adrenal crisis symptoms include:
- Low blood pressure
- Severe diarrhea and vomiting
- Loss of consciousness
- Severe and sudden pain in the legs, abdomen or lower back
Diagnosing Addison’s Disease
Without a comprehensive understanding of the individual’s medical history and a review of the patient’s symptoms, it is often challenging for doctors to diagnose adrenal insufficiency. Urine and hormone blood testing are crucial components to diagnosing the disease as is detecting a low level of cortisol and studying images of the patient’s pituitary and adrenal glands. Diagnosing Addison’s using urine and blood tests can help to quickly identify the disease. The doctor will likely perform to specific tests that include:
- ACTH (Adrenocorticotropic Hormone) Stimulation Testing – The doctor will inject synthetic adrenocorticotropic hormone through an IV (intravenous) needle to compare against blood and urine samples obtained prior to and after the injection was given. The doctor will then measure cortisol levels to see if the patient had a normal response to the hormone which would naturally cause urine and blood cortisol levels to rise. The individual suffering with primary or secondary adrenal insufficiency usually does not have an increase or only experiences a slight increase in their cortisol level.
- CRH (Corticotrophin-Releasing) Stimulation Testing – If the ACTH test result is abnormal, the doctor may then perform a corticotrophin-releasing stimulation test to focus in on what is causing the adrenal insufficiency. This two-hour test takes blood sample hormone measurements every 30 minutes after the patient is injected with synthetic CRH. Patients suffering from Addison’s (primary adrenal insufficiency) will fail to respond to the cortisol but not the high levels of Adrenocorticotropic Hormone. Patients suffering from secondary adrenal insufficiency will have a delayed response or have no response to the ACTH.
However, if the patient’s pituitary has been damaged, the corticotrophin-releasing test will fail to stimulate the Adrenocorticotropic Hormone, which is often indicative that the problem is with the pituitary gland. Any delay in the body’s response to Adrenocorticotropic Hormone is often indicative of a malfunctioning hypothalamus (the front of the brain that coordinates pituitary activity and autonomic nervous system involving body temperature, hunger, thirst, emotional activity, and sleep.
The patient’s physician may choose to use ultrasound tests, antibiotic blood tests, tuberculin skin tests, CT (computerized tomography) scans, hormonal blood tests and MRIs (magnetic resident imaging) to accurately diagnose the disease.
Treating Addison’s Disease
An effective treatment for Addison’s disease often involves prescription medications that could include corticosteroids designed to replace the body’s hormones that are not being produced naturally. These medications could include cortisone acetate, prednisone or hydrocortisone. If the body fails to produce sufficient amounts of aldosterone, the physician might choose to prescribe the patient fludrocortisone. Some physicians will prescribe dehydroepiandrosterone which has been known to improve women’s sex drive and mood.
An individual suffering from adrenal crisis should seek out intermediate medical care from a competent physician who will likely treat the patient with IV injections involving hydrocortisone, dextrose (sugar), and saline. This treatment can assist the body in restoring blood sugar levels, blood pressure and normalize potassium levels.
Treatment and Prognosis Complications
Many of the medications including hydrocortisone used to treat Addison’s disease can cause significant problems and unwanted side effects. The patient’s doctor can determine if the benefits of using hydrocortisone or another steroid outweigh its known side effects. Common complications using prescription medications to control Addison’s disease include:
- Fluid retention that leads to swollen ankles and feet
- Abdominal pain and indigestion
- Increased potential of developing infections
- Behavioral or mood changes
- Feeling tired/muscle weakness
- Difficulty in sleeping
- Irregular menstrual cycles
- Increased weight
Adrenal Crisis Prevention and Management
Any onset adrenal or Addisonian crisis requires immediate medical attention to avoid a fatal outcome. The patient’s doctor might be able to detect or identify many of the symptoms, signs or stressors known to trigger an Addisonian crisis. While this disease is rare, it is a very serious disorder. However, there are effective prescription drugs that can boost the patient’s cortisol hormone levels to ensure they remain healthy and live a long life.