ADDISONS DISEASE

04 Jun 2019

ABSTRACT –

Addison’s disease, also called as Hypocortisolism or Hypoadrenalism is a rare chronic disease of adrenal glands. In this condition, the glands do not produce sufficient amounts of steroid hormones like cortisol and aldosterone that are essential for the body.

CAUSES –

Insufficient production of cortisol is caused due to 3 main reasons:

  1. Impaired Steroidogenesis
  2. Adrenal Destruction
  3. Adrenal Dysgenesis

Impaired Steroidogenesis

Cortisol is synthesized from cholesterol in the adrenal glands by biochemically converting it to steroid hormones. Impaired Steroidogenesis is caused due to the inadequate supply of cholesterol to the glands or problem in synthesis of cortisol from cholesterol.

Adrenal Destruction

It is also known as Primary Adrenal Insufficiency and is the most common cause of Addison’s disease. Here the adrenal glands are inflamed or the adrenal cortex is damaged due to which the production of cortisol is affected.

Adrenal Dysgenesis

This is a rare genetic cause in which mutations lead to inadequate production of cortisol.

Adrenal gland failure may also be caused due to:

  • Adrenal gland infection
  • Tuberculosis
  • Bleeding of adrenal glands
  • Spread of cancer to the glands
  • Secondary gland insufficiency

SIGNS AND SYMPTOMS –

The symptoms of this disease gradually develop over months. The common symptoms can be linked to other disease conditions which include:

  • Nausea, vomiting and diarrhea
  • Headache and fever
  • Sweating
  • Weakness and lightheadedness on standing
  • Muscle weakness
  • Weight loss and Anorexia
  • Anxiety
  • Muscle and joint pains
  • Mood swings like depression
  • Salt craving and hypoglycemia
  • Alopecia
  • Irritability
  • Sexual dysfunction in women

Upon physical examination, these symptoms may also be observed:

  • Hyperpigmentation
  • Low blood pressure on standing
  • Addisonian crisis

Addisonian crisis: It is a severe adrenal insufficiency caused due to undiagnosed Addison’s disease or intercurrent problem, i.e., infection and trauma occurs during Addison’s disease. The symptoms for the same are:

  • Sudden pain in abdomen, legs or back
  • Dehydration due to severe vomiting and diarrhea
  • Hypotension
  • Hyperkalemia, hypercalcemia, hyponatremia and hypoglycemia
  • Neurological problems like convulsions and slurred speech
  • Fever
  • Severe lethargy
  • Syncope

DIAGNOSIS –

  • Blood test for detecting levels of dietary elements
  • ACTH stimulation test
  • Imaging test
  • Insulin-induced hypoglycemia test
  • Short test for checking blood cortisol levels after an hour of administration of tetracosactide
  • Long test for checking blood cortisol levels at different intervals in 24 hours after administration of tetracosactide.

TREATMENT –

The treatment for this disease is generally lifelong. The same treatment pattern is followed during Addisonian crisis:

  • Dietary supplements should be given to increase the depleted levels of essential elements like glucose
  • Increasing the hormone levels by giving orals or injection of corticosteroids
  • Patients are often advised to have knowledge about this disease and carry an information card to help them in case of emergency. They are also advised to carry a needle, syringe and injectable form of cortisol for emergency use.
  • During surgery period or dental treatment, they are recommended to increase the dose of medication.
  • Patients should always contact the doctor during any unknown crisis.

RISK FACTORS –

The risk factors for Addison’s disease are other autoimmune disease like Myasthenia gravis, Type 1 diabetes, Vitiligo, Chronic Thyroiditis etc.

EPIDEMIOLOGY –

  • Approximately 1 in 1,00,000 people suffer from Addison’s disease.
  • It is generally found in adults between 30-50 years of age.

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