What Is Addison's Disease?
What is Addison's Disease? Addison’s Disease is also called primary adrenal insufficiency, and occurs when the adrenal glands do not produce enough cortisol and aldosterone.
Adrenal insufficiency is a hormonal disorder of the adrenal glands. These are located in your body above the kidneys. There are two types of adrenal insufficiency:
- Primary - a condition of the adrenal glands
- Secondary - a result of the pituitary gland not functioning properly. The pituitary gland is a very small organ in the brain and it produces ACTH, which stimulates the adrenal glands to produce cortisol. When it fails to produce enough ACTH, then the adrenal glands make less cortisol. Over time, the adrenal glands shrink because of this lack of stimulation.
Cortisol is a hormone that affects almost every area in the body. Its main function is to help the body respond to stress. Other functions include:
- Regulating blood pressure and cardiovascular function
- Maintaining glucose levels in the blood
- Supporting immune functions
- Regulating the body’s inflammatory response
Aldosterone is produced by the adrenal glands and it regulates sodium and potassium levels in the body, helping to maintain blood pressure. It does this by signaling the kidneys to retain sodium and excrete potassium. If there is not enough aldosterone, the kidneys will not be able to maintain the proper salt and water balance, which will lead to a drop in blood pressure and volume.
What Is Addison's Disease?
Addison’s disease is primary adrenal insufficiency, and affects between one and four people out of every 100,000 people. Secondary adrenal insufficiency is more common than Addison’s disease. Symptoms include:
- Fatigue
- Loss of appetite
- Weight loss
- Muscle weakness
- Low blood pressure
- Salt cravings
- Nausea
- Darkening of the skin
Symptoms appear slowly and sometimes a traumatic event will cause them to get worse.
Any disease that causes the adrenal cortex to be destroyed or partially destroyed can cause Addison’s disease. Tuberculosis is one disease that can damage the adrenal glands. Cancer and chronic infection can also damage the adrenal cortex. If left untreated, Addison’s disease can be fatal.
Diagnosis
To continue with the answer to, “What is Addison's disease?” you will learn about how it is diagnosed. The most common test for detecting Addison’s disease is the ACTH stimulation test. Your blood and/or urine cortisol is measured before and after the test. Then you are injected with synthetic ACTH, and the cortisol levels should rise. If you have Addison’s disease, there will be little change in the levels.
Another test is the CRH stimulation test, where synthetic CRH is injected and the level of cortisol in the blood is measured before the injection and four times afterwards, at 30 minute intervals. CRH is the hormone produced by the hypothalamus which signals the pituitary gland. If you have Addison’s disease, you will have high levels of ACTH but no cortisol.
An X-ray, ultrasound, CT scan, or MRI may be administered to help identify the cause of your disease.
Treatment Options
Treatment consists of replacing the hormones that your body needs that are not being made by the adrenal glands. If you are in a crisis, these may be injected intravenously. Your doctor will probably tell you to increase salt consumption, and come back regularly to get your blood pressure checked and to have blood tests.
You need to carry identification stating your condition, in case of an emergency. Several occasions may call for your dosing to be changed. These include:
- Illness - Being ill can cause stress in your body and your dose of replacement hormones may need to be adjusted.
- Pregnancy - You will need to be monitored during pregnancy, as vomiting during the early stages may interfere with absorption. It may be necessary to have the medication injected rather than taken by mouth.
- Surgery - During surgery, the hormones may be given intravenously until after surgery, when you are fully awake and can take the medication orally.