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  • Addison's Disease

    (Adrenal Insufficiency; Adrenocortical Hypofunction; Chronic Adrenocortical Insufficiency; Hypoadrenalism)

    Definition

    Addison's disease is a rare disorder of the adrenal glands. With Addison's, the adrenal glands do not produce enough of the hormones cortisol and aldosterone.
    Adrenal Glands
    nucleus factsheet image
    Addison's occurs because of damage to the cortex.
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Addison's disease is the result of gradual damage to the outer layer of the adrenal gland. This damage may be caused by:
    • The body's own immune system attacking the gland. Known as an autoimmune disease. This cause accounts for 85% of cases in developed countries.
    • Tuberculosis —major cause in the Third World countries
    • Bleeding within the adrenal glands—related to use of anticoagulant medications and shock [extremely low blood pressure]
    • Surgical complication
    • Condition that are present at birth or due to genetic factors (enzyme defects, familial glucocorticoid insufficiency)
    • Cytomegalovirus (CMV) infection associated with AIDS
    • Fungal infections, including: Cancer including metastases from:
    • Medications (such as ketoconazole or etomidate)
    • Radiation treatment
    • Chronic illness, including:

    Risk Factors

    Factors that increases your chance of getting Addison's disease include:

    Symptoms

    Symptoms may include:
    • Extreme weakness, fatigue
    • Weight loss
    • Nausea or vomiting
    • Chronic diarrhea
    • Muscle weakness
    • Darkening of freckles, nipples, scars, skin creases, gums, mouth, nail beds, and vaginal lining
    • Emotional changes, especially depression
    • Craving for salty foods
    • Abdominal pain
    • Anorexia
    • Amenorrhea
    A severe complication of Addison's disease is the Addisonian or adrenal crisis . Adrenal crisis is a life threatening disorder, its symptoms include:
    • Severe abdominal, back, or leg pain
    • Fainting
    • Severe low blood pressure
    • Severe dehydration
    • Severe nausea, vomiting, and diarrhea
    • Low blood sugar
    • Generalized muscle weakness

    Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done.
    Tests may include:
      Blood and urine tests—to see if you have low levels of cortisol and aldosterone, high level of adrenocorticotropic hormone (ACTH is a hormone that stimulates the adrenal glands), and to measure levels of:
      • Sodium
      • Chloride
      • Calcium
      • Potassium
      • Bicarbonate
      • Blood urea nitrogen levels
      • Anti-adrenal antibody (rarely done)
    • ACTH stimulation test —measures cortisol in the blood before and after an injection of ACTH
    Your doctor may also need images of the abdomen and adrenal glands. This images may be taken with:

    Treatment

    Symptoms of Addison's disease can be controlled with medicines. These drugs replace the missing hormones. Medicine needs to be taken for the rest of your life. They may need to be increased during times of stress.
    Immediate treatment of adrenal crisis includes:
    • Self-injection of dexamethasone
    • Hydrocortisone by IV
    • Normal saline by IV

    Maintenance

    Regular blood tests are needed to monitor your response to medicine. Wear a medical alert bracelet that states adrenal insufficiency or Addison's disease. This will let others know of your condition if you are unable to communicate.

    Prevention

    There are no guidelines for preventing Addison's disease. If you think you are at risk, talk to your doctor.

    RESOURCES

    Addison's Disease.net http://www.addisonsdisease.net/

    The Adrenoleukodystrophy Foundation http://www.aldfoundation.org/

    National Adrenal Diseases Foundation http://www.nadf.us/

    CANADIAN RESOURCES

    The Canadian Addison Society http://www.addisonsociety.ca/

    Health Canada http://www.hc-sc.gc.ca/

    References

    Adrenocortical insufficiency. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us . Updated May 2, 2012. Accessed December 31, 2012.

    Addison's disease. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health/endo/pubs/addison/addison.htm . Accessed December 31, 2012.

    Arlt W, Allolio B. Adrenal insufficiency. Lancet . 2003;361(9372):1881-1893.

    Dorin RI, Qualls CR, Crapo LM. Diagnosis of adrenal insufficiency. Ann Int Med . 2003;138:3:194-214.

    Hahner S, Allolio B. Therapeutic management of adrenal insufficiency. Best Pract Res Clin Endocrinol Metab . 2009;23(2):167-79.

    Salvatori R. Adrenal insufficiency. JAMA . 2005;294:2481-2488.

    Ten S, New M, Maclaren N. Clinical Review 130: Addison's disease. J Clin Endo Metabol . 2001;86:2909-2922.

    Thomas Z, Fraser GL. An update on the diagnosis of adrenal insufficiency and the use of corticotherapy in critical illness. Ann Pharmather . 2007;41:1456-65.

    Wallace I, Cunningham S, Lindsay J. The diagnosis and investigation of adrenal insufficiency in adults. Ann Clin Biochem . 2009;46(Pt 5):351-367.

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