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Adrenal Insufficiency & Addison's Disease

Adrenal Insufficiency & Addison's Disease





overview


Addison's disease, also called adrenal insufficiency, is an uncommon illness that occurs when the body doesn't make enough of certain hormones. In Addison's disease, the adrenal glands make too little cortisol and, often, too little of another hormone, aldosterone.


Addison's disease can affect anyone and can be life-threatening. Treatment involves taking hormones to replace those that are missing.


Symptoms


Addison's disease symptoms usually happen slowly, often over months. The disease can move so slowly that people who have it may ignore the symptoms at first. Then a stress, such as illness or injury, makes symptoms worse.


Symptoms may include:


*Extreme fatigue

*Weight loss and loss of appetite

*Areas of darkened skin

*Low blood pressure, even fainting

*Salt craving

*Low blood sugar, also called hypoglycemia

*Nausea, diarrhea or vomiting

*Abdominal pain

*Muscle and joint pain

*Irritability

*Depression

*Body hair loss or sexual issues in some people


Acute adrenal failure, known as Addisonian crisis


Sometimes the symptoms of Addison's disease appear suddenly. Acute adrenal failure can lead to life-threatening shock. Seek emergency treatment for the following:


*Severe weakness

*Confusion

*Pain in the lower back or legs

*Severe abdominal pain, vomiting and diarrhea, leading to dehydration

*Reduced consciousness or delirium

*Low blood pressure


Causes


Addison's disease is caused by damage to the adrenal glands. The adrenal glands sit just above the kidneys. As part of the endocrine system, they make hormones that affect almost every organ and tissue in the body. Damage to these glands results in too little of the hormone cortisol and, often, the hormone aldosterone.


The adrenal glands are made up of two sections. The interior, called the medulla, makes adrenaline-like hormones. The outer layer, called the cortex, makes a group of hormones called corticosteroids. Corticosteroids include:


*Glucocorticoids. These hormones, including cortisol, affect the body's ability to turn food into energy. They also play a role in the immune system's inflammatory response and help the body respond to stress.

*Mineralocorticoids. These hormones, including aldosterone, balance the body's sodium and potassium to keep blood pressure in a healthy range.

*Androgens. In all people, the adrenal glands make small amounts of these sex hormones. They cause male sexual development. And they affect muscle mass, sex drive, known as libido, and a sense of well-being in all people.


Diagnosis



Your health care provider will talk to you about your medical history and your symptoms. You might have some of the following tests:


*Blood test. This test can measure blood levels of sodium, potassium, cortisol and adrenocorticotropic hormone (ACTH). A blood test also can measure antibodies related to autoimmune Addison's disease.

*ACTH stimulation test. ACTH tells the adrenal glands to make cortisol. This test measures the level of cortisol in the blood before and after a shot of human-made ACTH.

*Insulin-induced hypoglycemia test. This test is done to find out if the pituitary gland is causing secondary adrenal insufficiency. The test involves checking blood sugar and cortisol levels after a shot of insulin.

*Imaging tests. A CT scan of the stomach area checks the size of the adrenal glands and looks for other issues. An MRI of the pituitary gland can test for secondary adrenal insufficiency.


Treatment


Medicines are used to treat Addison's disease. Hormone replacement therapy corrects the levels of steroid hormones the body isn't making enough of. Some treatments include oral corticosteroids such as:


*Hydrocortisone (Cortef), prednisone (Rayos) or methylprednisolone (Medrol) to replace cortisol. These hormones are given on a schedule to act like the changes in cortisol levels the body goes through over 24 hours.

*Fludrocortisone acetate to replace aldosterone.

*You likely need plenty of salt in your diet. This is especially true during heavy exercise, when the weather is hot or if you have digestive upsets, such as diarrhea.


Your health care provider may increase your medicine for a short time if your body is stressed. Such stress can come from having surgery, an infection or a minor illness. If you're vomiting and can't keep down your medicine, you may need shots of corticosteroids.


Other treatment recommendations include:


*Carry a medical alert card and bracelet at all times. A steroid emergency card and medical alert identification let emergency care providers know what kind of care you need. Also have a written action plan.

*Keep extra medicine handy. It can be dangerous to miss even one day of medicine. So keep a small supply at work and with you when you travel.

*Carry a glucocorticoid injection kit. The kit contains a needle, a syringe and an injectable form of corticosteroids to use in case of emergency.

*Stay in contact with your care provider. Your care provider can monitor your hormone levels. If you have problems with your medicine, your provider might need to change the doses or when you take them.

*Have yearly checkups. At least once a year, see your care provider or a doctor who treats hormone problems. Your provider may recommend yearly screening for autoimmune diseases.

*An Addisonian crisis is a medical emergency. Treatment typically includes IV:


*Corticosteroids

*Saline solution

*Sugar

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