by Badash M

Addison Disease

(Adrenal Insufficiency; Adrenocortical Hypofunction; Chronic Adrenocortical Insufficiency; Hypoadrenalism)

Definition

Addison disease is a disorder of the adrenal glands. The adrenal glands sit on top of the kidneys and make important hormones. With Addison disease, the adrenal glands do not make enough of the hormones. The hormone cortisol is always affected but aldosterone may be low as well. Hormones affect systems throughout the body including blood pressure, metabolism, and the immune system. Addison disease may be:
  • Primary addison disease—adrenal gland tissue can not make hormones
  • Secondary addison disease—other hormones that tell adrenal glands what to do are missing or low
A severe complication of Addison's disease is the Addisonian or adrenal crisis. This is a life threatening crisis.
Adrenal Glands
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Addison's occurs because of damage to the cortex.
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Causes

Primary addison disease is caused by damage to the outer layer of the adrenal gland. This damage can happen slowly overtime.
Addison disease is most often caused by an autoimmune disease. For some reason, the immune system begin to attack healthy tissue. In this case, it attacks tissue of the adrenal gland.
Damage may also be caused by infections such as:
Less common causes include:
  • Certain cancers, including those that have spread
  • Amyloidosis—deposit of abnormal protein in tissue
  • Bleeding within the adrenal glands—may happen because of anticoagulant medications or shock
  • Surgical removal of glands
  • Genetic factors or birth defects that make it difficult for the adrenal glands to work properly
  • Certain medications
Secondary addison disease can be caused damage to the pituitary gland. The pituitary gland sends hormones that control the adrenal gland. If the pituitary gland is damaged it can not do its job well. Adrenal insufficiency may also occur after long term corticosteroids are stopped.

Risk Factors

Factors that may increase your chance Addison's disease include:

Symptoms

Symptoms of addison disease may include:
  • Extreme weakness, fatigue
  • Weight loss
  • Nausea or vomiting
  • Chronic diarrhea
  • Muscle weakness or pain
  • Darkening of freckles, nipples, scars, skin creases, gums, mouth, nail beds, and vaginal lining
  • Emotional changes, especially depression
  • Cognitive impairment or confusion
  • Craving salty foods
  • Abdominal pain
  • Lack of appetite
  • Amenorrhea
Symptoms of an adrenal crisis include:
  • High or low body temperature
  • Severe abdominal, back, or leg pain
  • Fainting
  • Severe dehydration
  • Severe nausea, vomiting, and diarrhea
  • Bluish skin color
  • Muscle weakness

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. If a problem with hormones is suspected your doctor may order:
  • Blood tests and urine tests to measure the amount of cortisol
  • ACTH stimulation test—should make the adrenal glands release cortisol
  • CRH stimulation test—can help determine if it is primary or secondary addison disease
Imaging tests may be needed to look at the adrenal glands. Tests may include:

Treatment

Addison disease can not be cured but can be managed with medication. These medications replace the missing hormones to decrease symptoms. They can also help prevent an adrenal crisis. An adrenal crisis will need immediate medical attention to try to balance the hormones again.
Regular blood tests are needed to monitor your response to medication. Wear a medical alert bracelet that states adrenal insufficiency or addison disease. This will let others know of your condition if you are unable to communicate.
Cortisol helps the body deal with stress. Those with addison disease need to take extra care during times of stress. Extra treatment may be needed during physical stress or recovery such as:
  • Surgery
  • Pregnancy
  • Severe illnesses or injuries

Prevention

There are no current guidelines to prevent addison disease.

RESOURCES

Family Doctor—American Academy of Family Physicians
http://familydoctor.org
National Adrenal Diseases Foundation
http://www.nadf.us

CANADIAN RESOURCES

Health Canada
http://www.hc-sc.gc.ca
The Canadian Addison Society
http://www.addisonsociety.ca

References

Adrenal insufficiency and Addison's disease. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/endocrine/adrenal-insufficiency-addisons-disease/Pages/fact-sheet.aspx Updated May 14, 2014. Accessed June 4, 2014.
Adrenal insufficiency in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116703/Adrenal-insufficiency-in-adults. Updated December 29, 2015. Accessed September 30, 2016.
Arlt W, Allolio B. Adrenal insufficiency. Lancet. 2003;361(9372):1881-1893.
Dorin RI, Qualls CR, Crapo LM. Diagnosis of adrenal insufficiency. Ann Int Med. 2003;138(3):194-214.
Hahner S, Allolio B. Therapeutic management of adrenal insufficiency. Best Pract Res Clin Endocrinol Metab. 2009;23(2):167-179.
Salvatori R. Adrenal insufficiency. JAMA. 2005;294(19):2481-2488.
Ten S, New M, Maclaren N. Clinical Review 130: Addison's disease. J Clin Endo Metabol. 2001;86(7):2909-2922.
Thomas Z, Fraser GL. An update on the diagnosis of adrenal insufficiency and the use of corticotherapy in critical illness. Ann Pharmather. 2007;419(9):1456-65.
Wallace I, Cunningham S, Lindsay J. The diagnosis and investigation of adrenal insufficiency in adults. Ann Clin Biochem. 2009;46(Pt 5):351-367.

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