In 1855 Thomas Addison, an English physician and scientists first discovered the disease after there was an outbreak of tuberculosis while he was working at Guy’s Hospital in London. Complications arising from the tuberculosis caused the patients’adrenal glands to fail. Nowadays TB is still the most contributory factor for Addison’s, but it is usually exclusive to Third World countries. Addison’s is an autoimmune disease due to the adrenal glands over or under producting cortisol as well as insufficient amounts of aldosterone. It is more common in women than men and the exact cause of the atrophy is unknown. It is a serious disease which can be life threathening. The adrenal glands are part of the endocrine system and have two sections, the interior (medulla) and the outer layer (cortex). The cortex produces hormones called corticosteroids. These are divided into three different areas.
• Glucocorticoids contain cortisol and enable the body to convert food into energy. They also help the body to respond to stress and support the immune systems inflammatory response.
• Mineralocorticoids contain aldosterone which regulates the body’s balance of sodium and potassium and helps to maintain normal blood pressure.
• Androgens are male sex hormones which are produced in small amounts by the adrenal glands in both men and women. They cause sexual development in men, and increase muscle mass, libido and a sense of well-being in both men and women.
Addison’s occurs when the adrenals fail to produce these hormones and the most significant cuase for this is an autoimmune disease. An autoimmune disease is when the body thinks that the cortex is harmful and attacks it. Other causes of adrenal failure is the spread of cancer to the glands, Tuberculosis, infections of the adrenal glands and bleeding into the adrenal glands.
Symptoms of Addison’s
• Darkening areas of skin
• Severe fatigue
• Lightheadedness or fainting
• Salt cravings
• Muscle or joint pains
• Weight loss and decreased appetite
Low blood pressure, even fainting
• Low blood sugar (hypoglycemia)
• Nausea, diarrhea or vomiting
• Abdominal pain
• Muscle or joint pains
• Irritability
• Depression
• Body hair loss or sexual dysfunction in women
Addison’s disease may also occur if the pituitary gland isn’t working properly. This gland produces the hormone adrenocorticotropic or (ACTH). When there is an inadequate supply of ACTH, it can lead to the improper functioning of the adrenal glands. This is called Secondary adrenal insufficiency. This can also be caused by people who have been on steroids for asthma or athritis and stop taking them without weaning off them.
Diagnosis
Blood test. Measuring your blood levels of sodium, potassium, cortisol and ACTH gives your doctor an initial indication of whether adrenal insufficiency may be causing your signs and symptoms. A blood test can also measure antibodies associated with autoimmune Addison’s disease.
ACTH stimulation test. This test involves measuring the level of cortisol in your blood
before and after an injection of synthetic ACTH. ACTH signals your adrenal glands to produce cortisol. If your adrenal glands are damaged, the ACTH stimulation test shows that your output of cortisol in response to synthetic ACTH is limited or nonexistent.
Insulin-induced hypoglycemia test. Occasionally, doctors suggest this test if pituitary disease is a possible cause of adrenal insufficiency (secondary adrenal insufficiency). The test involves checking your blood sugar (blood glucose) and cortisol levels at various intervals after an injection of insulin. In healthy people, glucose levels fall and cortisol levels increase.
Imaging tests. Your doctor may have you undergo a computerized tomography (CT) scan of your abdomen to check the size of your adrenal glands and look for other abnormalities that may give insight to the cause of the adrenal insufficiency. Your doctor may also suggest an MRI scan of your pituitary gland if testing indicates you might have secondary adrenal insufficiency
Treatment of Addison’s
Oral corticosteroids. Hydrocortisone (Cortef), prednisone or cortisone acetate may be used to replace cortisol. Your doctor may prescribe fludrocortisone to replace aldosterone.
Corticosteroid injections. If you’re ill with vomiting and can’t retain oral medications, injections may be needed.
