Addisons Disease – Diagnosis & Treatment

Addisons disease, also known as adrenal insufficiency, is a condition that occurs when the adrenal glands do not make enough specific hormones. The adrenal glands are small organs located on top of each kidney. They are responsible for producing hormones that one simply cannot live without, such as cortisol, aldosterone, and androgens. These hormones help regulate an individual’s metabolism, immune system, blood pressure, response to stress, and other essential functions that the body requires. Adrenal insufficiency can be primary, secondary, or tertiary. Addison’s disease is an acquired autoimmune condition that leads to primary adrenal insufficiency and decreased production of these indispensable hormones. It is a rare disease, as the incidence is 0.6 cases per 100,000 population per year. With proper treatment, most people can have a normal life expectancy and active life. If not treated, this rare disease can cause life-threatening low blood pressure, low blood glucose, low blood sodium, and high blood potassium. The most severe complication of the disorder is called adrenal crisis. If not treated immediately, it can cause death.1,2

The etiology of the disease is direct injury to the adrenal cortex that results in adrenal insufficiency. Autoimmune destruction of the adrenal glands is the most common cause of Addisons disease. In developed countries, autoimmune disease causes 8 or 9 of every 10 cases of Addisons disease. Other possible causes include infections (such as sepsis, tuberculosis, and HIV) or bilateral adrenal hemorrhages. More rare causes include sarcoidosis, amyloidosis, fungal infections, and genetic disorders such as adrenal leukodystrophy and Wolman disease.1,2

The pathophysiology of Addisons disease involves the development of 21-hydroxylase antibodies, which mistakenly attacks the tissue of the adrenal gland. This will eventually lead to adrenal failure. Decreased cortisol production is usually the first stage of the disease, quickly followed by that of aldosterone. Diminished levels of both of these hormones causes an increase in adrenocorticotropic hormone (ACTH) and plasma renin levels in the blood. This is a result of the loss of negative feedback inhibition in the body.2

Clinical Presentation

 Most of the symptoms that one can experience are usually insidious with a gradual onset. The symptoms related to Addison’s disease are fairly non-specific and can overlap with many other disease states; making this disorder difficult to identify early in its course. The most common symptoms that a patient with Addison’s disease will present with are chronic fatigue, muscle weakness, loss of appetite, weight loss, and abdominal pain. Other possible symptoms include nausea, vomiting, diarrhea, low blood pressure, dizziness/fainting, depression, joint pain, salt cravings, low blood glucose, and no sexual motivation. Hyperpigmentation of the skin is a condition that is an identifier representing a more progressed disease. This is due to elevated ACTH levels within the body.1,2

Addison’s disease is more likely to be present in women than men and often occurs in individuals between the ages of 30 and 50, although it can occur at any age. Prominent risk factors associated with developing the disease include having a related family history, as well as concomitant autoimmune disorders. Certain infections such as tuberculosis, HIV/AIDS, sepsis and candidiasis have also been linked to the development of Addison’s Disease. Use of anticoagulants has been discussed as a relative risk factor for the disorder, but more studies need to be conducted to confirm this risk.1,2

Diagnosis

 As mentioned earlier, the early stages of Addison’s disease are difficult to identify due to its broad range of symptoms and its gradual onset. A valid suspicion may be made if an individual’s symptoms do correlate with their past medical history, but more tests will need to be conducted in order to confirm the diagnosis. Blood tests will need to be undertaken in order to confirm the presence of adrenal insufficiency. The most common type of blood test used to confirm adrenal insufficiency is an ACTH stimulation test. With this test, a provider will inject a patient with man-made ACTH; which acts the same way as endogenous ACTH. A normal response of the injection is a rise in blood cortisol levels. In patient with Addison’s disease, there will be little or no increase in cortisol levels. Other tests that can be used, usually when results of the ACTH stimulation test are not clear, are an insulin tolerance test and CRH stimulation test.1

Once a diagnosis of adrenal insufficiency is made, the next step is to determine the cause. For Addison’s disease, blood tests are performed to detect the presence of antibodies commonly found in the disease (21-hydroxylase antibodies). If the test shows antibodies, no further testing is needed, and Addison’s disease is the confirmed cause. If no antibodies are present, which is a rare occasion, a CT scan of the abdomen can be performed to find abnormalities in the adrenal glands.  

Treatment

 The treatment of Addison’s disease consists of hormone replacement therapy. This involves the patient taking hormone medications that their adrenal glands are not making and will need higher doses during times of physical stress. For cortisol hormone replacement, patients usually take hydrocortisone two to three times a day by mouth. More potent glucocorticoid options include prednisone and dexamethasone but are often less prescribed.1

If the patient’s adrenal glands are not producing sufficient aldosterone hormone levels, they will be prescribed fludrocortisone; which will help balance the amount of sodium and fluids in the body. Hydrocortisone does play a role in the mineralocorticoid system, so patients on this medication may not need the addition of fludrocortisone. However, patients on prednisone or dexamethasone will need the addition of fludrocortisone if aldosterone levels are insufficient due to these medications having no effect on mineralocorticoid receptors. If you are looking for proper treatment for addison’s disease, then you can ask a doctor online by visiting our website: https://justhealthexperts.com/

Conclusion

Addison’s disease is a rare condition and is often the cause of primary adrenal insufficiency. In this disease, the adrenal glands do not function properly, which results in diminished adrenal hormone levels. The symptoms of the disease are generally non-specific which makes it difficult to diagnose in the early stages of the disorder. The treatment of Addison’s disease consists of hormone replacement therapy. If the disease is left untreated, it can cause a condition called adrenal crisis which can be life-threatening. Providers, as well as patients, need to be aware of the risk factors that can predispose an individual to the disease in order to identify it early and reduce the risk of morbidity and mortality. Addison disease is related to adrenal inefficiency & if you take proper supplement for adrenal then it will be recovered successfully. To learn more about adrenal & cortisol supplement, kindly visit this link: natural approaches to adrenal & cortisol health

References 

  1. Adrenal Insufficiency & Addison’s Disease. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/endocrine-diseases/adrenal-insufficiency-addisons-disease/all-content. Published September 1, 2018. Accessed June 12, 2020
  2. Munir S, Waseem M. Addison Disease. [Updated 2020 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441994/

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