by Badash M

Addison's Disease

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

Definition

Addison's disease is a rare disorder of the adrenal glands. With Addison's, the adrenal glands do not produce enough of the hormones cortisol and aldosterone.
Adrenal Glands
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Addison's occurs because of damage to the cortex.
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Causes

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

Risk Factors

Factors that increase your chance of getting Addison's disease include:

Symptoms

Symptoms 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
  • Anorexia
  • Amenorrhea
A severe complication of Addison's disease is the Addisonian or adrenal crisis . Adrenal crisis is a life threatening disorder, its symptoms 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.
Your bodily fluids may be tested. This can be done with:
  • Blood tests
  • Urine tests
  • ACTH stimulation test
Your doctor may also need images of your bodily structures. This can be done with:

Treatment

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 need to be increased during times of stress.
Immediate treatment of adrenal crisis includes:
  • Self-injection of dexamethasone
  • Hydrocortisone by IV
  • Normal saline by IV
Surgery may also be needed for adrenal tumors or pituitary tumors causing the disease.

Maintenance

Regular blood tests are needed to monitor your response to medication. Wear a medical alert bracelet that states adrenal insufficiency or Addison's disease. This will let others know of your condition if you are unable to communicate.

Prevention

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

RESOURCES

The Adrenoleukodystrophy Foundation http://www.aldfoundation.org

National Adrenal Diseases Foundation http://www.nadf.us

CANADIAN RESOURCES

The Canadian Addison Society http://www.addisonsociety.ca

Health Canada http://www.hc-sc.gc.ca

References

Adrenal insufficiency and Addison's disease. National Endocrine and Metabolic Diseases Information Service website. Available at: http://endocrine.niddk.nih.gov/pubs/addison/addison.aspx. Updated May 14, 2014. Accessed June 4, 2014.

Adrenal insufficiency in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 16, 2013. Accessed June 4, 2014.

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):167-79.

Salvatori R. Adrenal insufficiency. JAMA. 2005;294:2481-2488.

Ten S, New M, Maclaren N. Clinical Review 130: Addison's disease. J Clin Endo Metabol. 2001;86:2909-2922.

Thomas Z, Fraser GL. An update on the diagnosis of adrenal insufficiency and the use of corticotherapy in critical illness. Ann Pharmather. 2007;41:1456-65.

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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