Addison’s disease

Addison’s disease, also known as adrenal insufficiency, is a rare disorder that affects the adrenal glands. Adrenal glands are 2 small glands located on top of the kidneys. They produce hormones called cortisol and aldosterone. Cortisol controls blood sugar level and helps the body respond to stress whereas aldosterone keeps the normal level of salt and water in the bloodstream. Addison’s disease occurs due to failure of the adrenal glands to produce sufficient amount of these hormones. These hormones affect almost every organ and tissue in the body. The onset of the disease may occur at any age and affects both men and women equally.

Symptoms

The symptoms of Addison’s disease can vary from patient to patient. Early-stage symptoms are similar to other conditions such as flu or depression. It usually develops slowly but in some cases develop rapidly. Common symptoms include: * Weight loss * Muscle weakness * Low blood sugar level * Lack of energy (fatigue) * Loss of appetite * Low mood * Darkening of the skin

If Addison disease is not treated, this condition may worsen into a severe condition called an addisonian crisis. Addisonian crisis or acute adrenal failure is a life threatening situation. It occurs when the level of cortisol in the body falls significantly. If left untreated, it can be fatal. The symptoms may appear suddenly and you may experience: * Severe pain in lower back, abdomen or legs * Sudden loss of strength * Severe vomiting and diarrhea * Low blood pressure * Difficulty breathing * Kidney failure

Causes

Addison’s disease can occur due to different reasons. The most common cause is an autoimmune response, which occurs when the immune system— that normally defends against infection— mistakenly attacks the adrenal cortex, disrupting the production of steroid hormones.

Other possible causes that can destroy the adrenal gland are infections, like tuberculosis, hemorrhage (bleeding into the adrenal gland), injury to the adrenal gland, cancer and genetic defects.

Types

There are 2 types of adrenal insufficiency:

Primary adrenal insufficiency

Primary adrenal insufficiency occurs due to the damage to the adrenal glands by an autoimmune disease, infections like tuberculosis, cancer or any other disease. In this type, adrenal glands are damaged so severely that they no longer produce hormones— Cortisol and aldosterone. Insufficient production of these two hormones leads to symptoms like—fatigue, change in skin color, mood changes.

Secondary adrenal insufficiency

When adrenal glands cannot produce hormones because of other reasons such as due to abnormalities of the pituitary gland, it is referred to as secondary adrenal insufficiency. It occurs when pituitary gland can’t produce adrenocorticotropic hormone (ACTH). ACTH stimulates the adrenal gland to produce cortisol.

Diagnosis

Diagnosis is confirmed based upon thorough clinical evaluation and patient history. Your doctor will ask you about medical history and other symptoms. He/ She may also advise certain laboratory tests like- Blood test, ACTH stimulation test, MRI, CT scan. The blood test is done to measure cortisol, ACTH, sodium and potassium levels in your body. Diagnosis is confirmed by a combination of these tests. CT scan or MRI scans are done to check the shape and size of adrenal glands and the pituitary.

Treatment

Medications are given to replace the missing hormone. Treatment often begins with administration of corticosteroid. It replaces the hormones – cortisol and aldosterone that your body no longer produces. Common drugs include hydrocortisone, prednisolone or dexamethasone. These are taken in tablet form, 2-3 times a day and are taken for the rest of the life. Aldosterone is replaced with fludrocortisone and you may be required to increase salt intake.

Generally, these medicines cause no side effects, unless your dose is too high. Taking too much of these medicines may cause problems such as weight gain, weakened bones, difficulty sleeping or even diabetes.


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