What Is Addison's Disease?
Addison’s disease, otherwise called primary adrenal insufficiency or hypocortisolism, is a condition caused when the adrenal glands do not produce sufficient hormones like cortisol and aldosterone. It can affect people of all ages and sexes and can be fatal. Adrenal glands are located above the kidneys and produce hormones needed for the normal functioning of the body. Cortisol is released in response to physical and emotional stress and helps the body to react in such situations. Aldosterone regulates the body's potassium and sodium levels.
What Causes Addison's Disease?
Depending on the cause, Addison’s disease is classified into the following two types:
1) Primary Adrenal Insufficiency:
Primary adrenal insufficiency is when the adrenal cortex, which is the outer part of the adrenal gland, does not produce enough adrenocortical hormones. It is most commonly caused when the body attacks its cells, an autoimmune condition. Sometimes, the body mistakes the adrenal cortex for a virus or bacteria and attacks and destroys it. Most people with this type of Addison’s disease also have some other autoimmune conditions like type 1 diabetes, vitiligo, or hypothyroidism. The other causes include:
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Infections of the body or adrenal gland.
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Tuberculosis (infectious disease).
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Amyloidosis (protein buildup in some organs).
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Indiscriminate use of glucocorticoids like Prednisone.
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Cancer or tumor involving the adrenal gland.
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The use of blood thinners results in bleeding into the adrenal gland.
2) Secondary Adrenal Insufficiency:
Secondary adrenal insufficiency results when the pituitary gland does not produce the adrenocorticotropic hormone (ACTH). ACTH is produced by the pituitary gland, and this hormone stimulates the adrenal cortex to release its hormones. In the absence of ACTH, the adrenal cortex does not produce cortisol, aldosterone, and androgens, which results in Addison’s disease. The conditions that can cause this are:
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Benign pituitary tumors.
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Inflammation of the pituitary gland.
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Medications.
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Prior pituitary surgery.
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Traumatic brain injury.
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Genetics.
Here, even though the adrenal cortex is not damaged, there is a lack of glucocorticoids and androgens normally produced by the adrenal glands. Thus, it is called secondary adrenal insufficiency. Mineralocorticoids, which are also hormones produced by the adrenal cortex and regulate the salt and water balance in the body, are not affected by less production of ACTH.
Adrenal insufficiency can also result when people who are under treatment with corticosteroids for conditions like asthma and arthritis stop taking medicine abruptly.
What Are the Risk Factors for Addison's Disease?
The factors that increase the risk of a person getting Addison’s disease are:
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Treatment with blood thinners.
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Chronic infections like tuberculosis.
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Autoimmune conditions like arthritis (joint inflammation) and Graves’ disease (overactive thyroid).
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Partial adrenalectomy (part of the adrenal gland is surgically removed).
What Is the Addisonian Crisis?
Untreated Addison's disease can result in an Addisonian crisis. Usually, the adrenal gland produces more hormones in response to stress, injury, infection, or illness. In Addison’s disease, as these hormones cannot be produced more when needed, it causes an Addisonian crisis. It causes low blood pressure, low blood glucose levels, and high levels of potassium in the blood and can be fatal.
What Is Addison's Vs Cushing Disease?
Addison's disease and Cushing's disease are both endocrine disorders involving the adrenal glands, but they occur due to different causes and manifest with distinct sets of symptoms. The condition occurs due to infections, cancer, and certain medications. The symptoms include fatigue, weakness, weight loss, nausea, vomiting, and low blood pressure. Cushing syndrome is a condition in which the adrenal glands produce excess cortisol. The symptoms include weight loss, thinning of the skin, easy bruising, muscle weakness, high blood pressure, glucose intolerance, mood changes, and fatigue. The condition can be managed by surgery, radiation therapy, and medications.
What Are the Symptoms of Addison's Disease?
The symptoms develop slowly over several months and are not usually diagnosed until stress or illness worsens the symptoms. The signs and symptoms are:
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Extreme tiredness.
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Loss of appetite.
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Weight loss.
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Hyperpigmentation (dark skin).
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Hypotension.
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Loss of consciousness.
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Salt craving.
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Hypoglycemia (low blood glucose).
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Nausea.
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Diarrhea.
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Vomiting.
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Stomach pain.
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Muscle ache.
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Joint pain.
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Irritability.
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Hair loss.
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Sleep disturbances.
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Lack of energy.
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Sexual dysfunction.
If left untreated for long, it can result in an Addisonian crisis or acute adrenal failure. It is a life-threatening situation, and if an individual notices the following signs and symptoms, get immediate medical help.
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Extreme fatigue.
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Confusion.
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Lower back pain.
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Leg pain.
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Severe stomach pain.
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Dehydration due to vomiting and diarrhea.
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Hypoglycemia.
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Hyperkalemia (high potassium).
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Hyponatrium (low sodium).
What Is Addison's Disease Life Expectancy?
The life expectancy of Addison's disease is managed with appropriate treatment. With proper treatment, like hormone replacement therapy, an individual can live a normal and productive life. If the condition is left untreated or poorly managed, it can lead to life-threatening complications, such as severe infections, electrolyte imbalance, and adrenal crisis.
How Is Addison's Disease Diagnosed?
Based on the signs and symptoms, if the doctor suspects this disease, they will suggest the following tests:
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Blood Pressure - The blood pressure is checked when the patient is sitting and shortly after standing up. Low blood pressure is a symptom of Addison’s disease.
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Blood Tests - Blood test shows low sodium, low glucose, and high potassium.
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Urine Test - The cortisol levels in the urine will be low.
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ACTH Stimulation Test - Here, an injection of synthetic ACTH is given, and the level of cortisol in the blood is checked before and after this injection.
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Insulin-Induced Hypoglycemia Test - This is done to diagnose secondary adrenal insufficiency. Here, the blood sugar and cortisol levels are checked after injecting Insulin. In a healthy person, the glucose level falls, and the cortisol level rises.
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MRI (Magnetic Resonance Imaging) and CT (Computed Tomography) Scan - The size of the adrenal glands is checked, and the pituitary gland is checked for any abnormality.
How Is Addison's Disease Treated?
The doctor will plan the treatment depending on the type and severity of the condition. If left untreated for a long time, it can result in a life-threatening condition called Addisonian crisis.
Medications:
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Glucocorticoid Drugs - These drugs stop inflammation and improve health.
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Hormone Replacements - To replace the hormones that the adrenal glands are unable to produce.
Home Remedies: Keep an injectable corticosteroid handy in cases of Addison’s crisis.
Other Therapies:
As too much stress can result in acute adrenal failure, keeping the stress under control is crucial. Meditation, yoga, and other stress-relieving therapies can help.
An individual needs to take medicines for the rest of their life, as they will help manage symptoms and prevent acute adrenal failure. Take these medications as prescribed by the doctor, and never skin or stop a drug abruptly. Go for regular checkups, as the dosage and medicines might need to be changed depending on the condition. For more information on this condition, consult professionally trained and experienced endocrinologists online.
Conclusion
Addison's disease is a condition that is caused by the reduced production of cortisol and aldosterone hormones. This condition affects the adrenal gland, which produces cortisol and aldosterone hormones. Addison's disease is treatable through medication, such as oral corticosteroids and hormonal replacement therapy. Affected individuals need to work closely with healthcare providers to develop a personalized treatment plan.