Addison's disease

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Addison's disease
Synonyms	Primary adrenal insufficiency, hypocortisolism
Pronounce	N/A
Specialty	N/A
Symptoms	Fatigue (medical), muscle weakness, weight loss, hyperpigmentation, hypotension, abdominal pain, nausea, vomiting, diarrhea, salt craving
Complications	Adrenal crisis
Onset	Gradual
Duration	Long-term
Types	N/A
Causes	Autoimmune adrenalitis, tuberculosis, adrenal hemorrhage, infections, metastatic cancer
Risks	Autoimmune diseases, genetic predisposition
Diagnosis	ACTH stimulation test, serum cortisol, electrolyte imbalance
Differential diagnosis	Secondary adrenal insufficiency, congenital adrenal hyperplasia, hypothyroidism
Prevention	None
Treatment	Glucocorticoid and mineralocorticoid replacement therapy
Medication	Hydrocortisone, fludrocortisone
Prognosis	Good with treatment
Frequency	4.4–6.0 per 100,000 per year
Deaths	Rare with treatment

Addison's disease occurs when the adrenal glands do not produce enough of the hormones cortisol and aldosterone (both corticosteroids). It is also known as chronic adrenal insufficiency, or hypocortisolism. It can make people feel weak and tired, but it can also be effectively treated with replacement steroids.

Types of Addison’s disease

There are two main types of Addison’s disease.

• Primary adrenal insufficiency: the adrenal glands do not produce enough cortisol and aldosterone
• Secondary adrenal insufficiency: the pituitary gland in the brain does not release enough of the hormone that stimulates the adrenal gland to release cortisol.

What causes Addison’s disease?

Addison’s disease may be caused by anything that damages the adrenal glands, such as:

Patient with Addison's disease

• autoimmune disease where the immune system attacks some of the bodies own tissues)
• Infection of the adrenal glands
• blood loss, blood thinning drugs
• cancer in the adrenal glands
• bleeding in the adrenal glands
• tuberculosis
• conditions such as type 1 diabetes
• genetic defects
• disease in the pituitary glands
• If you suddenly stop taking corticosteroids for conditions like asthma or arthritis.

It can also be caused by anything that affects the pituitary gland in the brain, such as a tumour.

Addison’s disease symptoms

The symptoms of Addison’s disease start gradually and can include:

• a darkening of the skin, with or without sun exposure
• weight loss
• low blood pressure and sometimes fainting
• fatigue and muscle weakness
• loss of appetite
• salt cravings
• low blood sugar
• abdominal pain
• muscle or joint pains
• poor growth in children
• nausea, vomiting and diarrhoea
• irritability and depression
• menstrual periods that become irregular or stop
• Loss of hair
• Sexual problems in women.

What is an Addisonian crisis?

An Addisonian crisis can occur when an accident or illness causes symptoms to worsen. These can include sudden pain in the lower back, legs or abdomen, low blood pressure, severe vomiting and diarrhoea and loss of consciousness. An untreated Addisonian crisis can be fatal. In the case of accident, illness, vomiting or diarrhoea people with Addison’s disease must have their medication adjusted according to their specific needs.

Addison’s disease diagnosis

Addison’s disease can be diagnosed in a variety of ways, including:

• blood tests to determine hormone levels
• a blood sugar test
• X-ray, MRI or CT scan to look at the structure of the adrenal or pituitary glands
• medical and family history.

Addison’s disease treatment

Treatment for Addison’s disease requires life-long steroid replacement therapy. This includes corticosteroid tablets, corticosteroid injections, androgen replacement and sometimes increased sodium (salt) intake. People with Addison’s disease are advised to wear an identification disc or bracelet noting treatment in an emergency.