Addison disease is a condition that occurs when the body does not generate acceptable amounts of specific proteins made in the adrenal glands. The adrenal gland will produce inadequate amounts of coritsol and aldosterone in some instances. It is also refered to as adrenal insufficiency or hypocorticsolism. It may manifest at any age however the customary age of infection is between 30-50 years of age. It may also possibly progress into a life threatening illness.
The underlying causes of the disease may be categorized into two different groups primary adrenal insufficiency and secondary adrenal insufficiency. In the first case the cause is related directly to the deterioration of the adrenal glands and in the second instance it signifies the impairment of another organ which then leads to the dysfunction of the adrenal glands.
Primary Adrenal Insufficiency
Addison disease will materialize when the cortex is impaired and stops producing satisfactory amounts of hormones. This is considered primary adrenal insufficiency.
The gland stops making adrenocortical hormones because the body begins attacking itself. It is still not understood why the immune system identifies the adrenal cortex as foreign and thus attacks it.
Adrenal gland failure may also occur because of cancer, tubercolosis, bleeding into the adrenal glands and other infections.
Secondary Adrenal Insufficiency
This form of the illness may occur if the pituitary gland is infected with a disease. The pituitary gland generates the hormone adrenocorticotropic hormone (ACTH) which encourages the adrenal cortex to make its hormones. When the ACTH levels are deficient this may lead to a decrease in the hormones produced by the adrenal glands even if they are unharmed. This is why it is considered secondary adrenal insufficiency because it does not involve direct impairment of the glands themselves.
A possible secondary factor may arise from patients who take corticosteroids and then suddenly stop taking them resulting in the malfunction of the glands.
The associated symptoms of the disease will generally take several months to manifest and will include:
- Weight loss and a marked decrease in appetite
- Hyperpigmentation or darkening of the skin
- A desire to eat salt
- Muscle weakness
- Low blood pressure
- Hypoglycemia or low blood sugar
- Addisonian Crisis/Acute Adrenal Failure
- It is also possible to experience symptoms quite quickly after initial degeneration of the glands’ function. Symptoms will include:
- Hyperkalemia or high potassium levels
- Low blood pressure
- Losing consciousness
- Lower back, leg and abdnominal pain
- Uncontrollable vomiting and diarrhoea
If the disease is detected in the early phase corticosteroid will be prescribed. Because of the fall in hormone levels supplementary hormones will be administered to raise the levels. Hydrocortisone, cortisone acetate or predinidone are used to replace cortisol. Aldosterone will be replaced by Fludrocortisone (Florinef) which is needed to control sodium and potassium levels to regularize blood pressure.
The hormones are ingested on a day to day basis in the usual amounts manufactured by the body thus imitating the body’s natural process. If the body is significantly weakened due to stress then the hormone replacement medications will be increased to counteract the negative impact the stress may create. If it is impossible to take the medication orally because of vomiting, corticosteroid injections may be used instead.
If there is an androgen deficiency then androgen replacement with dehydroepiandrosterone will ensue. Studies have shown where this is beneficial to a woman’s well being.
In cases of Addisonian crisis, emergency treatment may be necessary. It will normally require intravenous injections of saline solution, sugar and hydrocortisone.