Addison’s Disease - Symptoms, Causes, Diagnosis, and Treatment

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 potassium and sodium in the body.

What Are the Symptoms of Addison’s Disease?

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:

• Extreme tiredness.

• Loss of appetite.

• Weight loss.

• Hyperpigmentation (dark skin).

• Hypotension.

• Loss of consciousness.

• Salt craving.

• Hypoglycemia (low blood glucose).

• Nausea.

• Diarrhea.

• Vomiting.

• Stomach pain.

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• Muscle ache.

• Joint pain.

• Irritability.

• Depression.

• Hair loss.

• Sleep disturbances.

• Lack of energy.

• Sexual dysfunction.

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.

• Extreme fatigue.

• Confusion.

• Lower back pain.

• Leg pain.

• Severe stomach pain.

• Dehydration due to vomiting and diarrhea.

• Delirium.

• Hypoglycemia.

• Hyperkalemia (high potassium).

• Hyponatrium (low sodium).

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, 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.

• Tuberculosis.

• 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.

• Medications.

• Prior pituitary surgery.

• Traumatic brain injury.

• 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:

• Cancer.

• 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).

What Is 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.

How Is Addison’s Disease Diagnosed?

Based on your signs and symptoms, if the doctor suspects this disease, he or she will suggest the following tests:

1. 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.

2. Blood tests - Blood test shows low sodium, low glucose, and high potassium.

3. Urine test - The cortisol levels in the urine will be low.

4. 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.

5. 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.

6. MRI and CT scan - 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 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.

Medications:

• 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.

Other Therapies:

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.