Addison's disease
Definition
Addison's disease is a disorder that occurs when the adrenal glands do not produce enough of their hormones.
Causes
The adrenal glands are small hormone-secreting organs located on top of each kidney. They consist of the outer portion (called the cortex) and the inner portion (called the medulla).
The cortex produces 3 types of hormones:
- The glucocorticoid hormones (such as cortisol) maintain sugar (glucose) control, decrease (suppress) immune response, and help the body respond to stress.
- The mineralocorticoid hormones (such as aldosterone) regulate sodium and potassium balance.
- The sex hormones, androgens (male) and estrogens (female), affect sexual development and sex drive.
Addison's disease results from damage to the adrenal cortex. The damage causes the cortex to produce less of its hormones.
This damage may be caused by the following:
- The immune system mistakenly attacking the gland (autoimmune disease)
- Infections such as tuberculosis, HIV, or fungal infections
- Hemorrhage, blood loss
- Tumors
- Use of blood-thinning drugs (anticoagulants)
Risk factors for the autoimmune type of Addison's disease include other autoimmune diseases:
- Chronic thyroiditis
- Dermatis herpetiformis
- Graves' disease
- Hypoparathyroidism
- Hypopituitarism
- Myasthenia gravis
- Pernicious anemia
- Testicular dysfunction
- Type I diabetes
- Vitiligo
Certain genetic defects may cause these conditions.
Symptoms
- Changes in blood pressure or heart rate
- Chronic diarrhea
- Darkening of the skin - patchy skin color
- Unnaturally dark color in some places
- Paleness
- Extreme weakness
- Fatigue
- Loss of appetite
- Mouth lesions on the inside of a cheek (buccal mucosa)
- Nausea and vomiting
- Salt craving
- Slow, sluggish movement
- Unintentional weight loss
Treatment
Treatment with replacement corticosteroids will control the symptoms of this disease. However, you will usually need to take these drugs for life. People often receive a combination of glucocorticoids (cortisone or hydrocortisone) and mineralocorticoids (fludrocortisone).
The health care provider may increase the medication dose in times of:
- Infection
- Injury
- Stress
During an extreme form of adrenal insufficiency, adrenal crisis, you must inject hydrocortisone immediately. Supportive treatment for low blood pressure is usually needed as well.
Some people with Addison's disease are taught to give themselves an emergency injection of hydrocortisone during stressful situations. It is important for you to always carry a medical identification card that states the type of medication and the proper dose needed in case of an emergency.
Never skip doses of your medication for this condition, because life-threatening reactions may occur.
Prognosis
With hormone replacement therapy, most people with Addison's disease are able to lead normal lives.