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Addison's Disease

Alternative names: Adrenal Insufficiency, Hypocortisolism, Adrenocortical Hypofunction

What is Addison's disease?
What are the signs of Addison's disease?
What causes Addison's disease?
How does my doctor tell if I have Addison's disease?
How is Addison's disease treated?

What is Addison's disease?

The adrenal glands are located on the top of your kidneys, and produce adrenaline, cortisol, aldosterone, and other steroid hormones that enable the body to respond to stress. Addison's disease occurs when the adrenal glands do not produce enough of the hormones your body needs to work properly. This affects the balance of water, sodium, and potassium in the body, and harms its ability to control blood pressure and react to stress.

What are the signs of Addison's disease?

The hormone deficiencies caused by Addison's disease can produce many symptoms, including:

  • Feeling weak and fatigued
  • Weight loss
  • Loss of appetite
  • Low blood pressure
  • Darkening of the skin, especially at the elbows, knees, knuckles, toes, lips, and mucous membranes. This happens because the pituitary gland tries to stimulate the under-producing adrenal glands by making a hormone that also stimulates melanin production, which is responsible for skin color.
  • A craving for salt, caused by low levels of cortisone and aldosterone, hormones that help balance the body's fluid and salt levels
  • Irregular or absent menstrual perods in female patients
  • Nausea, vomiting, and diarrhea
  • Hypoglycemia, or low blood sugar

Symptoms can become worse during a stressful event, such as injury, surgery, or psychological stress.

What causes Addison's disease?

Most cases of Addison's disease are caused by an autoimmune reaction, in which the body's immune system attacks and destroys the outer part of the adrenal glands (the cortex). In other cases, the glands have been damaged by cancer, an infection such as tuberculosis, or another disease.

Secondary adrenal insufficiency is similar to Addison's disease, and is caused when the pituitary gland does not create enough of the hormone ACTH, which tells the outer part of the adrenal glands to produce hormones.

How does my doctor tell if I have Addison's disease?

Because Addison's disease can be difficult to diagnose, your doctor may want to perform one or more of the following tests:

  • ACTH is a hormone made by the pituitary gland that tells the outer part of the adrenal gland to produce hormones. An ACTH stimulation test measures levels of the hormone cortisol in your blood and urine, before and after you are given a synthetic form of ACTH. Normally, a person's cortisol levels will increase after the ACTH injection. The cortisol levels of a patient with Addison's disease do not rise in the same way after the ACTH injection.
  • The CRH stimulation test can help determine the cause of adrenal insufficiency. Blood cortisol levels are measured before and after the injection of CRH; the reaction of these levels can tell a doctor if the problem is with the pituitary glands, the hypothalamus, or the adrenal glands.
  • X-ray exams of the adrenal and pituitary glands can check for signs of damage to the glands.
  • A CT (computerized tomography) scan makes X-rays of the adrenal glands to check their size and shape.

How is Addison's disease treated?

 

Doctors treat Addison's disease with medications that replace the hormones not made by the adrenal glands. Patients usually must take these medications for life.

  • Hydrocortisone tablets replace missing cortisol.
  • Fludrocortisone acetate replaces aldosterone. Patients receiving this therapy are usually advised to increase their salt intake.

Medication may need to be increased during times of stress, infection, or injury. Some patients may need emergency injections of hydrocortisone during stressful situations.

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