Published on Oct 10, 2019 - 5 min read
Addison's disease, also called adrenal insufficiency, is a rare endocrine disorder that affects the adrenal gland. Learn about its causes, symptoms, diagnosis, and treatment.
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 potassium and sodium in the body.
The symptoms develop slowly over several months, and it is not usually diagnosed until stress or illness makes the symptoms worse. The signs and symptoms are:
Loss of appetite.
Hyperpigmentation (dark skin).
Loss of consciousness.
Hypoglycemia (low blood glucose).
Lack of energy.
If left untreated for long, it can result in Addisonian crisis or acute adrenal failure. It is a life-threatening situation, and if you notice the following signs and symptoms, get immediate medical help.
Lower back pain.
Severe stomach pain.
Dehydration due to vomiting and diarrhea.
Hyperkalemia (high potassium).
Hyponatrium (low sodium).
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, which is called an autoimmune condition. Sometimes, the body mistakes the adrenal cortex as 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:
Infections of the body or adrenal gland.
Amyloidosis (Protein buildup in some organs).
Indiscriminate use of glucocorticoids like Prednisone.
Cancer or tumor involving the adrenal gland.
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 make the hormone 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:
Benign pituitary tumors.
Inflammation of the pituitary gland.
Prior pituitary surgery.
Traumatic brain injury.
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.
The factors that increase the risk of a person getting Addison’s disease are:
Treatment with blood thinners.
Chronic infections like tuberculosis.
Autoimmune conditions like arthritis and Graves’ disease.
Partial adrenalectomy (part of the adrenal gland is surgically removed).
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.
Based on your signs and symptoms, if the doctor suspects this disease, he or she will suggest the following tests:
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.
Blood tests - Blood test shows low sodium, low glucose, and high potassium.
Urine test - The cortisol levels in the urine will be low.
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.
Insulin-induced hypoglycemia test - It 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.
MRI and CT scan - Size of the adrenal glands is checked, and the pituitary gland is checked for any abnormality.
The doctor will plan your treatment depending on the type and severity of your condition. If left untreated for a long time, it can result in a life-threatening condition called Addisonian crisis.
Glucocorticoid drugs - these drugs stop inflammation and improve your health.
Hormone replacements - to replace the hormones that your adrenal glands are unable to produce.
Home Remedies:Keep an injectable corticosteroid handy in cases of Addison’s crisis.
As too much stress can result in acute adrenal failure, keeping your stress under control is crucial. Meditation, yoga, and other stress-relieving therapies can help.
You need to take medicines for the rest of your life, as they will help manage symptoms and prevent acute adrenal failure. Take your medications as prescribed by your 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 your condition. For more information on this condition, consult professionally trained and experienced endocrinologists online.
Patients suffering from Addison's disease are expected to live a normal life. The average life expectancy in Addison's patients is 64 years. Until the patient follows up their medicines properly, death is unlikely. Only when the patient fails to take his or her medicines, the adrenal crisis occurs and causes death.
Addison's disease occurs when the body's adrenal glands are unable to produce hormones on their own. Yes, Addison's disease is serious, and it could be life-threatening if left untreated.
Foods that are highly rich in sodium can benefit the patient suffering from Addison's disease. Since the drugs that are used to treat Addison's are more likely to cause osteoporosis, it is essential for the patient to have an adequate dietary intake of calcium and vitamin D containing foods.
Yes, if the person has his or her Addison's disease in control, by taking medications and having regular follow-ups with the doctor, the person can lead a normal life. Only if the person has other linked comorbidities, patients might not be able to lead a normal life.
It is noted that Addison's disease is rarely genetic. It is known as autoimmune Addison's disease. The complete mechanism is still not understood. Various studies are going on to explain the combination of genetic and environmental influence in Addison's disease.
The most common initial signs of Addison's disease are the skin patches. Those skin patches are noted to be darker than the surrounding skin. It is known as hyperpigmentation. This type of skin presentation typically occurs near to scars and creases of the body.
Adrenal glands produce the stress hormones of the body. They are responsible for the person to manage his or her stressful conditions. Normal people cannot live without adrenal glands. If a person's adrenal glands are removed due to any reason, the person would need a lifetime supplement of hormones. Without hormone replacement, the person cannot survive.
Cortisol levels in the body are measured with an interval of 30 minutes to 60 minutes. It is also done overnight, and the cortisol level in the dexamethasone suppression test to confirm the diagnosis of Addison's disease. Usually, it can be diagnosed within a day or two, excluding the time taken during the history and physical examination.
Addison's disease usually progresses slowly. But, in a condition known as an acute adrenal failure, the disease may manifest immediately. It usually requires several months to a year for the disease to develop completely. But a stressful condition like trauma can also immediately manifest the disease in an acute manner.
Mild Addison's disease is usually seen only in people who have physical stress. The common symptoms in mild Addison's are fatigue, headache, and weight loss. These patients have to take hormonal supplements for the hormone their adrenal glands are not producing.
The diagnosis of Addison's disease can be made if the person is suspected of having the diseases by the symptoms presented. It usually takes only one or two days to diagnose Addison's disease in a patient with clinical symptoms.
Regular balanced meals with healthy snacks help the patient maintain his or her cortisol levels. Foods like white sugar, white flour, alcohol, caffeine, soda, fried foods, processed foods, fast foods should be avoided by a person suffering from Addison's disease.
People who are suffering from certain chronic, life-threatening conditions like tuberculosis and any kind of cancers are at risk of getting affected by Addison's disease. In addition, people who are under certain medicines such as anticoagulants (Warfarin) can easily get affected by the disease.
Stress can not cause Addison's disease. But, it worsens the disease in patients. This is due to the reason that the body is unable to produce its own stress hormones. Therefore, the stress in Addison's patient can worsen the disease condition.
Addison's disease is primarily a disease of the adrenal glands. But, the hormones produced by those glands normally exert their action almost in all organ systems of the body. Thus, Addison's disease is capable of affecting all organ systems, especially the cardiovascular system and the glands of the body.
The only mode of reliable treatment so far in Addison's disease is hormone replacement therapy. It involves the replacement of steroid hormones that are unable to be naturally produced by the body. Some medicines that are used to replace the hormones are Hydrocortisone, Prednisone, and Methylprednisolone.
Treatment is highly mandatory in a person suffering from Addison's disease. Since the body lacks adequate levels of stress hormones, if a person with Addison's goes through a stressful condition, the person will not be able to survive the stress. So, the person might die. Thus, proper replacement of hormones and regular follow-ups is essential.
If Addison's disease is left untreated, a condition called adrenal crisis may occur. It presents with severe abdominal pain, severe weakness, extremely low blood pressure, kidney failure, and shock. Thus, Addison's disease can cause kidney failure.
The initial signs that would lead that would make the doctor suspect Addison's disease is darkening areas of skin (hyperpigmentation), severe fatigue, unintentional weight loss, gastrointestinal problems such as nausea, vomiting, and abdominal pain, lightheadedness or fainting, salt cravings, and muscle or joint pains.
No, with proper treatment, Addison's disease is not a disability. The only difficulty is the lifetime intake of hormonal supplements. People with Addison's disease can lead a normal life.
One of the symptoms seen in Addison's disease is the blurring of vision. Thus, Addison's disease can affect the eyesight of the patient. If you are suffering from Addison’s disease for a long time, you should consult your doctor immediately.
Patients with Addison's disease often complain of memory and attention difficulties, even when they are on standard hormone-replacement therapy. Still, no clear studies have been established about the link between Addison's disease and memory loss.
There were studies conducted about the effects of Addison's disease on the normal sleep patterns of patients. There was no evidence to prove that sleep disturbances with Addison's disease. They were noted to have extended day time fatigue, but their nighttime sleep was noted to be normal.
The hormonal replacement drugs that are used to treat Addison's disease are corticosteroids. These drugs on long term use are known to produce side effects on the musculoskeletal system. This condition is known as osteoporosis. Thus, proper calcium and vitamin D maintenance drugs, according to the physician's advice, must also be taken regularly.
Histoplasmosis is a rare fungal disease that is noted to cause Addison's disease. The incidence of this fungal infection is more common in the immunocompromised category of patients. Thus, adequate precautions must be taken against acquiring fungal infections.
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