Addison's Disease

Addison's disease is a rare disorder of the adrenal glands. In the case of Addision's, the glands do not produce enough of the hormones cortisol and aldosterone.

Addison's disease is the result of gradual damage to the adrenal cortex, the outer layer of the adrenal gland. This damage may be caused by:

• Bleeding within the adrenal glands (related to use of anticoagulant medications and shock (low blood pressure))
• Cancer including metastases from:
  • Breast , lung , kidney , or colon cancer
  • Kaposi's sarcoma
  • Lymphoma
• Chronic illness, including:
  • Adrenoleukodystrophy
  • Adrenomyelodystrophy
  • Amyloidosis
  • Hemachromatosis
  • Sarcoidosis
• Fungal infections, including:
  • Blastomycosis
  • Coccidioidomycosis
  • Histoplasmosis
• Medications (such as ketoconazole or etomidate)
• Congenital (present at birth) or genetic factors (enzyme defects, familial glucocorticoid insufficiency)
• Cytomegalovirus (CMV) associated with AIDS
• Radiation treatment
• Surgical complication
• The body's immune system attacking the gland (autoimmune disease), which accounts for 85% of cases in developed countries
• Tuberculosis (major cause in the Third World countries)

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

• Having the following autoimmune diseases can put you at risk for an associated autoimmune-based Addison’s disease:
  • Pernicious anemia
  • Hyperthyroidism (Grave’s disease) or hypothyroidism (Hashimoto’s disease)
  • Hypoparathyroidism
  • Hypopituitarism
  • Myasthenia gravis
  • Type I diabetes
• Long-term steroid medication treatment, followed by:
  • Infection
  • Severe stress
  • Surgery
  • Trauma
• Abdominal injury
• Anticoagulant medications
• Family members with autoimmune-caused Addison's disease
• Previous surgery on adrenal glands
• Stress

Symptoms may include:

• Chronic diarrhea
• Emotional changes, especially depression
• Abdominal pain
• Amenorrhea
• Anorexia
• Craving for salty foods
• Darkening of freckles, nipples, scars, skin creases, gums, mouth, nail beds, and vaginal lining
• Extreme weakness, fatigue
• Muscle weakness
• Nausea or vomiting
• Weight loss

A severe complication of Addison's disease is the Addisonian or adrenal crisis . Adrenal crisis is a life threatening disorder, its symptoms include:

• Fainting
• Generalized muscle weakness
• Low blood sugar
• Severe abdominal, back, or leg pain
• Severe dehydration
• Severe low blood pressure
• Severe nausea, vomiting, and diarrhea

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include:

• Blood and urine tests—to see if you have low levels of cortisol and aldosterone, high level of ACTH (ACTH is a hormone that stimulates the adrenal glands), and to measure levels of:
  • Anti-adrenal antibody (rarely done)
  • Bicarbonate
  • Blood urea nitrogen levels
  • Calcium
  • Chloride
  • Potassium
  • Sodium
• ACTH stimulation test —measures cortisol in the blood before and after an injection of ACTH
• CT scan of the abdomen—a type of x-ray that uses a computer to make pictures of structures inside the body, in this case the adrenal glands
• X-rays —pictures of the abdomen to see if the adrenal glands have signs of calcium deposits

Symptoms of Addison's disease can be controlled with medications. These drugs replace the missing hormones. Medication needs to be taken for the rest of your life. They may be increased in times of stress.

Medications may include:

• Cortisone acetate
• Fludrocortisone acetate (Florinef)
• Hydrocortisone tablets

Immediate treatment of adrenal crisis includes:

• Hydrocortisone by IV (into vein)
• Normal saline (salt water) by IV

There are no guidelines for preventing Addison's disease. If you think you are at risk, talk to your doctor.