Addison’s Disease: Causes, Risk Factors, Symptoms, Diagnosis and Treatment

It is an endocrine system disorder in which the adrenal glands do not produce enough steroid hormones.

It is characterized by a series of relatively nonspecific symptoms, such as abdominal pain and weakness, but in certain circumstances, these can progress to Addison’s crisis, a serious illness that can include very low blood pressure, leading to coma.

Addison’s disease is caused by a partial or complete failure of the outer layer of a person’s adrenal glands, which produce hormones that control various bodily functions.

The disease involves a chronic deficiency of cortisol, aldosterone, and adrenal androgens.

When a person’s body is deficient in these hormones, they can experience low salt and high potassium levels that cause an electrolyte imbalance in their body.

The most important job that cortisol has is to help a person respond to stress, it also helps to maintain cardiovascular function, blood pressure and to decrease the inflammatory response of a person’s immune system.

It also acts by regulating the effects of insulin on the breakdown of sugars for energy, and on the regulation of carbohydrate, fat and protein metabolism.

The hypothalamus and the pituitary gland regulate cortisol.

In fact, one of the main functions of the pituitary gland is to secrete adrenocorticotropin, a hormone that stimulates a person’s adrenal glands.

The adrenal glands are located just above your kidneys, producing cortisol and other hormones called “corticosteroids.”

Some of these corticosteroid hormones are essential for life.

Addison’s disease commonly occurs in people between the ages of 30 and 50, although it can affect people of any age or gender.

Causes of Addison’s disease

There are a few different reasons why a person may not make enough cortisol like:

Primary adrenal insufficiency

This occurs when there is a disorder of the adrenal glands of a person.

Secondary adrenal insufficiency

This occurs when the pituitary gland does not secrete enough adrenocorticotropin.

The most common form of Addison’s disease involves autoimmune destruction of the adrenal glands that can occur alone or as part of a syndrome.

Additional causes of Addison’s disease can include tuberculosis, adrenal hemorrhage, or genetic disorders.

People who have been receiving a form of glucocorticoid hormone like Predinsone to treat another disorder who suddenly stop taking it may experience a temporary type of secondary adrenal insufficiency.

Symptoms of Addison’s disease

Addison’s disease has a number of different symptoms that often start slowly.

Fatigue, muscle weakness, weight loss, and loss of appetite are the characteristic symptoms of the disease.

Half of all people with Addison’s disease experience diarrhea, nausea, and vomiting.

People with the disease often experience low blood pressure that drops further when they stand up, causing them to feel dizzy or even faint.

Skin changes are also common in people with Addison’s disease, many times they experience areas of dark tan covering their skin that is most visible in skin folds, scars, and pressure points.

People with Addison’s disease may experience depression and irritability.

Salty food cravings are common due to the loss of salt from your system.

Children with the disease are affected by low blood sugar more often than adults.

Women with Addison’s disease may experience menstrual periods that may be irregular or stop altogether.

Symptoms of Addison’s disease, for about 25 percent of affected people, do not appear until they experience an ” Addison’s crisis .”

Addison’s disease symptoms tend to progress slowly, causing people to ignore them until a stressful event, illness, or accident makes symptoms worse.

The Addison crisis requires immediate medical attention; Such a crisis can be fatal.

Symptoms of an Addison crisis include:

  • Dehydration
  • Low blood pressure.
  • Loss of consciousness.
  • Severe vomiting and diarrhea.
  • Sudden, piercing pain in the lower back, abdomen, or legs.

Risk factor’s

Risk factors for the autoimmune type of Addison’s disease include other autoimmune diseases such as:

  • Vitiligo.
  • Type I diabetes.
  • Hipopituitarism.
  • Graves’ disease.
  • Miastenia serious.
  • Chronic thyroiditis.
  • Pernicious anemia.
  • Hypoparathyroidism.
  • Testicular dysfunction.
  • Dermatis herpetiformis.

Diagnosis of Addison’s disease

When Addison’s disease is in its early stages it can be difficult to diagnose.

Doctors diagnose the disease through a review of a person’s medical history, symptoms, a physical exam, and blood tests.

The goal of laboratory tests is to determine not only the cortisol levels in the person’s system and whether or not they are sufficient, but also to establish a cause.

A doctor can also order X-rays.

There are a couple of different lab tests that a doctor can order in relation to Addison’s disease such as:

Adrenocorticotropic hormone stimulation test

The adrenocorticotropic hormone stimulation test measures cortisol in the person’s blood and urine before they receive an injection of a synthetic form of adrenocorticotropic hormone.

In the “rapid” adrenocorticotropic hormone test, a person’s blood cortisol level is measured 30 to 60 minutes after the adrenocorticotropic hormone injection.

The expected answer is that the person’s adrenocorticotropic hormone levels in both the blood and urine will increase.

Corticotropin-releasing hormone stimulation test

The corticotropin-releasing hormone stimulation test is required when a person has responded poorly to the adrenocorticotropin hormone stimulation test and helps determine the cause of adrenal insufficiency.

During the test, an intravenous injection of synthetic corticotropin-releasing hormone is given and your blood cortisol is measured not only before; but thirty, sixty, ninety and one hundred and twenty minutes after receiving the injection.

A high level of adrenocorticotropic hormone is indicative of primary adrenal insufficiency and they do not produce cortisol.

Deficient cortisol responses indicate secondary adrenal insufficiency with absent or delayed adrenocorticotropic hormone responses.

An absent adrenocorticotropic hormone response suggests that the person’s pituitary is the cause. A delayed adrenocorticotropic hormone response suggests that your hypothalamus is the cause.

In people who have been diagnosed with primary adrenal insufficiency, the doctor will order X-rays to find out if their adrenal glands show signs of calcium deposits, which could indicate tuberculosis.

The doctor may also order a tuberculosis skin test.

In people who have been diagnosed with secondary adrenal insufficiency the doctor may order a CT scan to determine other treatment methods, as well as additional methods of pituitary gland testing and hormonal tests.

Addison’s disease treatment

Treatment of Addison’s disease involves using a combination of glucocorticoids and mineralocorticoids to replace those that the body is not making.

Cortisol is replaced with hydrocortisone tablets that can be taken once or twice a day.

If the person also experiences an aldosterone deficiency, they can take a mineralocorticoid called ‘fludrocorisone’ once a day.

In people taking fludrocorisone it is recommended to increase the amount of salt they eat.

People with secondary adrenal insufficiency generally continue to produce the amount of aldosterone they need.

The amount of these medications is adjusted to meet the individual requirements of each person.

People who are experiencing an Addison’s crisis accompanied by low blood sugar, low blood pressure, and high potassium levels are at great risk of life.

Doctors commonly treat Addison’s crisis with injections of hydrocortisone, saline, and dextrose, producing rapid improvement in the person involved.

Once the patient is able to ingest fluids and take oral medications, the amount of hydrocortisone is decreased, until a maintenance dose is reached.

Doctors cannot make a reliable diagnosis of Addison’s disease while a person is being treated for an Addisonian crisis.

A doctor can; however, measure adrenocorticotropic hormone and cortisol in the person’s blood both during the attack and before glucocorticoid administration.

These measures are usually sufficient to make a diagnosis. Once the crisis is over and the related medications have stopped, the doctor usually waits up to a month to make an accurate diagnosis.