Question

    Addison's Disease (Addisons Disease)

    Addisons hyperpigmentation[1]

    Addison’s disease is a chronic clinical disease characterized by the progressive decline in the function of the adrenal glands. This potentially fatal disease may result in hyperpigmentation, hypotension, and cardiovascular collapse. Addison’s disease is easily diagnosed clinically and by the use of hormonal assays that reveal an elevated adrenocorticotropic hormone (ACTH) with a low plasma cortisol level.

    The disease is the result of the following process: endocrine.

    Presentation

    Addison’s disease has a typical insidious and chronic onset which may take several months. The following signs and symptoms are usually presented by patients with primary adrenal insufficiency:

    On occasions, the symptomatology of Addison’s disease may appear acutely or abruptly. The acute onset of adrenal insufficiency symptoms is clinically referred to as Addisonian crisis. The following signs and symptoms are typically observed in acute adrenal failure:

    Jaw & Teeth
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  • Entire body system
    Anorexia
    • They may suffer hypoglycemic symptoms some hours after a large carbohydrate meal but usually their anorexia prevents them from consuming sufficient carbohydrate to do this ...[herballegacy.com]
    • Symptoms Patients usually present with anorexia, nausea and vomiting.[symptoma.com]
    • Signs and symptoms include weakness, weight loss, joint pain, postural hypotension, headache, anorexia, constipation, diarrhea, hyperpigmentation, hyponatremia, hyperkalemia, hypoglycemia, and hypercalcemia.[openanesthesia.org]
    • Clinical symptoms include ANOREXIA; NAUSEA; WEIGHT LOSS; MUSCLE WEAKNESS; and HYPERPIGMENTATION of the SKIN due to increase in circulating levels of ACTH precursor hormone which stimulates MELANOCYTES.[fpnotebook.com]
    • The following symptoms are commonly observed in dogs: Lethargy Lack of appetite (anorexia) Vomiting Weight loss Diarrhea Shaking Increased frequency of urination ( polyuria ) Increased thirst ( polydipsia ) Depression Dehydration Weak pulse Collapse Low[petmd.com]
    Fatigue
    • Not everyone who is fatigued has adrenal fatigue.[earthclinic.com]
    • The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and sometimes darkening of the skin in both exposed and nonexposed parts of the body.[askjan.org]
    • Muscular fatigue and weakness are fairly common with hyperpigmentation of the skin.[symptoma.com]
    • Fatigue, weight loss, low blood pressure and hyperpigmentation are symptoms of the disease.[sharecare.com]
    • Common symptoms include: weakness fatigue abdominal pain nausea weight loss low blood pressure darkened skin (in the case of Addison’s disease) salt craving (in the case of Addison’s disease) dizziness upon standing depression However, there are different[endocrineweb.com]
    Fever
    • Symptoms include: fatigue muscle weakness joint or muscle pain fever weight loss nausea , vomiting , and or diarrhea (leading to dehydration ) headache sweating changes in mood or personality, such as irritability, anxiety , or depression loss of appetite[familydoctor.org]
    • That can happen for many reasons, such as an illness, fever, surgery, or dehydration.[massgeneral.org]
    • […] order to accomplish this, we need to increase our awareness for the disease and add primary adrenal insufficiency early to the list of differential diagnosis in severely ill patients with particular symptoms and signs like hypotension, hyponatremia , fever[endocrinologyadvisor.com]
    • Adrenal crisis is characterized by fever , vomiting , diarrhea , and a precipitous fall in blood pressure.[britannica.com]
    • The signs and symptoms include fatigue; lightheadedness upon standing or difficulty standing, muscle weakness, fever, weight loss, anxiety, nausea, vomiting, diarrhea, headache, sweating, changes in mood or personality, and joint and muscle pains.[en.wikipedia.org]
    Hypothermia
    • This may exhibit itself as confusion and disorientation, epileptic fits, hypothermia, and even coma.[herballegacy.com]
    Weakness
    • A disease caused by partial or total failure of adrenocortical function, characterized by a bronzelike pigmentation of the skin and mucous membranes, anemia, weakness, nausea, and low blood pressure.[dictionary.reference.com]
    • Other features include muscle weakness, susceptibility to infection, elevated blood sugar levels (hyperglycemia), and weak bones (osteoporosis).[lifeextension.com]
    • On examination of dogs with Addison’s disease one may see depression, weakness, dehydration, weak pulses and sometimes a slow, irregular heart rate.[vetmed.wsu.edu]
    • After taking a history and completing a physical exam to look for clinical signs like dehydration, a weak or slow pulse rate, irregular heartbeat, generalized weakness, or depression, your veterinarian will probably perform a complete blood count and[healthypets.mercola.com]
    Weight Loss
    • The testosterone was administered to combat the weight loss and gonadal atrophy associated with the steroids he was taking.[articles.latimes.com]
    • Deficient production of both these hormones can cause a number of symptoms like weakness, dehydration , low blood pressure , depression, heart toxicity, vomiting, blood in feces, and weight loss.[petmd.com]
    • Symptoms include Weight loss Muscle weakness Fatigue that gets worse over time Low blood pressure Patchy or dark skin Lab tests can confirm that you have Addison disease.[fpnotebook.com]
    • Common symptoms include: weakness fatigue abdominal pain nausea weight loss low blood pressure darkened skin (in the case of Addison’s disease) salt craving (in the case of Addison’s disease) dizziness upon standing depression However, there are different[endocrineweb.com]
    • Symptoms include • Weight loss • Muscle weakness • Fatigue that gets worse over time • Low blood pressure • Patchy or dark skin Lab tests can confirm that you have Addison disease.[youtube.com]
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  • neurologic
    Asthenia
    • 1. a disease characterized by asthenia, low blood pressure, and a brownish coloration of the skin, due to decreased secretion of cortisol from the adrenal cortex, resulting in hypoadrenalism. 1855-60; named after T.[dictionary.reference.com]
    • Adrenal crisis Adrenal crisis is characterized by Profound asthenia Severe pain in the abdomen, lower back, or legs Peripheral vascular collapse Renal shutdown with azotemia Body temperature may be low, although severe fever often occurs, particularly[merckmanuals.com]
    Dizziness
    • Common symptoms include: weakness fatigue abdominal pain nausea weight loss low blood pressure darkened skin (in the case of Addison’s disease) salt craving (in the case of Addison’s disease) dizziness upon standing depression However, there are different[endocrineweb.com]
    • Symptoms of Addison disease include: Chronic diarrhea, nausea, and vomiting Darkening of the skin in some places Dehydration Dizziness when standing up Low-grade fever Extreme weakness , fatigue , and slow, sluggish movement Darker skin on the inside[nlm.nih.gov]
    • Symptoms of adrenal crisis include: Abdominal pain Difficulty breathing Dizziness or lightheadedness Low blood pressure Reduced level of consciousness References Barthel A, Willenberg HS, Gruber M, Bornstein SR.[mountsinai.org]
    • Symptoms may include muscle weakness, fatigue, and dizziness.[urmc.rochester.edu]
    • Symptoms of Addison’s disease Symptoms may begin with tiredness, dehydration, dizziness and cramps.[news-medical.net]
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  • Skin
    Hyperpigmentation
    • Muscular fatigue and weakness are fairly common with hyperpigmentation of the skin.[symptoma.com]
    • Hyperpigmentation of the gum line in a patient with Addison's Disease.[pedclerk.bsd.uchicago.edu]
    • These patients are not likely to have hyperpigmentation, hyperkalemia, and increased BUN.[merckmanuals.com]
    • Signs and symptoms include weakness, weight loss, joint pain, postural hypotension, headache, anorexia, constipation, diarrhea, hyperpigmentation, hyponatremia, hyperkalemia, hypoglycemia, and hypercalcemia.[openanesthesia.org]
    • Clinical symptoms include ANOREXIA; NAUSEA; WEIGHT LOSS; MUSCLE WEAKNESS; and HYPERPIGMENTATION of the SKIN due to increase in circulating levels of ACTH precursor hormone which stimulates MELANOCYTES.[fpnotebook.com]
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  • respiratoric
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  • gastrointestinal
    Abdominal Pain
    • Common symptoms include: weakness fatigue abdominal pain nausea weight loss low blood pressure darkened skin (in the case of Addison’s disease) salt craving (in the case of Addison’s disease) dizziness upon standing depression However, there are different[endocrineweb.com]
    • If left untreated, Addison's disease can cause severe abdominal pain, weakness, low blood pressure, kidney failure and shock.[childrenshospital.org]
    • pain, hyperpigmentation, or hypoglycemia .”[endocrinologyadvisor.com]
    • pain, extreme weakness, low blood pressure, kidney failure, and shock--especially when the child is experiencing physical stress.[stanfordchildrens.org]
    • pain ... steatorrhoea [increase fecal fat excretion] to the extent of 30 gm. fat per day, without diarrhea...[herballegacy.com]
    Chronic Diarrhea
    • Back to Top Symptoms Symptoms of Addison disease include: Chronic diarrhea, nausea, and vomiting Darkening of the skin in some places, causing the skin to look patchy Dehydration Dizziness when standing up Paleness Extreme weakness , fatigue , and slow[nytimes.com]
    • Symptoms of Addison disease include: Chronic diarrhea, nausea, and vomiting Darkening of the skin in some places Dehydration Dizziness when standing up Low-grade fever Extreme weakness , fatigue , and slow, sluggish movement Darker skin on the inside[nlm.nih.gov]
    • Symptoms Symptoms of Addison disease include: Chronic diarrhea, nausea, and vomiting Darkening of the skin in some places Dehydration Dizziness when standing up Low-grade fever Extreme weakness , fatigue , and slow, sluggish movement Darker skin on the[mountsinai.org]
    • She was anorexic, vomited frequently, and had chronic diarrhea.[whole-dog-journal.com]
    Diarrhea
    • Excessive diarrhea and vomiting among patients may also benefit from the sodium supplementations.[symptoma.com]
    • Addisonian patients may present with lethargy, diarrhea, vomiting, increased thirst, increased urination, and unplanned weight loss.[vcahospitals.com]
    • Get medical care for your child right away if he or she has vomiting or diarrhea or other illness.[urmc.rochester.edu]
    • Loss of water, in vomit and diarrhea, can lead to dehydration.[vetmed.wsu.edu]
    • ... vague abdominal pain ... steatorrhoea [increase fecal fat excretion] to the extent of 30 gm. fat per day, without diarrhea...[herballegacy.com]
    Loss of Appetite
    • Other symptoms include weight loss, nausea, loss of appetite, salt cravings, and dehydration.[sharecare.com]
    • They include weakness, lack of energy, loss of appetite, increased thirst and urination, vomiting, and sudden collapse.[healthypets.mercola.com]
    • Symptoms may include: Muscle weakness Fatigue Dizziness Rapid pulse Dark skin (first noted on hands and face) Black freckles Bluish-black discoloration around the nipples, mouth, rectum, scrotum, or vagina Weight loss Dehydration Loss of appetite Intense[stanfordchildrens.org]
    • The most common symptoms of Addison's are a loss of appetite, vomiting, diarrhea, weakness, depression and lethargy.[poodlehealthregistry.org]
    • Worsening chronic fatigue and muscle weakness, loss of appetite and weight loss are characteristic of the disease.[healthcentral.com]
    Nausea
    • Symptoms Patients usually present with anorexia, nausea and vomiting.[symptoma.com]
    • Common symptoms include: weakness fatigue abdominal pain nausea weight loss low blood pressure darkened skin (in the case of Addison’s disease) salt craving (in the case of Addison’s disease) dizziness upon standing depression However, there are different[endocrineweb.com]
    • A disease caused by partial or total failure of adrenocortical function, characterized by a bronzelike pigmentation of the skin and mucous membranes, anemia, weakness, nausea, and low blood pressure.[dictionary.reference.com]
    • When a patient has an illness which causes nausea and vomiting (such that they cannot hold down their medications), he or she will need to enter a medical facility where IV medications can be administered.[encyclopedia.com]
    • Signs and symptoms include low blood pressure, nausea and vomiting, syncope, hypoglycemia, hyponatremia, hyperkalemia, a metabolic acidosis, lethergy, confusion, and convulsions.[openanesthesia.org]
    Salt Craving
    • Common symptoms include: weakness fatigue abdominal pain nausea weight loss low blood pressure darkened skin (in the case of Addison’s disease) salt craving (in the case of Addison’s disease) dizziness upon standing depression However, there are different[endocrineweb.com]
    • craving Muscle aches Nausea Vomiting Diarrhea Intolerance to cold If not treated, Addison's disease may lead to severe abdominal pain, extreme weakness, low blood pressure, kidney failure, and shock--especially when the child is experiencing physical[stanfordchildrens.org]
    • craving Weight loss with reduced appetite Back to Top Treatment Treatment with replacement corticosteroids will control the symptoms of this disease.[nytimes.com]
    • craving (eating food with a lot of added salt) Weight loss with reduced appetite The health care provider will perform a physical exam and ask about the symptoms.[nlm.nih.gov]
    • The following signs and symptoms are usually presented by patients with primary adrenal insufficiency: Anorexia Weight loss Fatigue Muscular weakness Hyperpigmentation Hypotension Syncope Hypoglycemia Salt cravings Nausea and vomiting Diarrhea Myositis[symptoma.com]
    Severe Abdominal Pain
    • If left untreated, Addison's disease can cause severe abdominal pain, weakness, low blood pressure, kidney failure and shock.[childrenshospital.org]
    • abdominal pain, extreme weakness, low blood pressure, kidney failure, and shock--especially when the child is experiencing physical stress.[stanfordchildrens.org]
    • If left untreated, Addison's disease may lead to: Severe abdominal pain Extreme weakness Low blood pressure Kidney failure Shock from dehydration Severe complications are most likely to occur when the child is under physical stress.[urmc.rochester.edu]
    • If not treated, adrenal insufficiency may result in severe abdominal pains, vomiting, profound muscle weakness and fatigue, depression , extremely low blood pressure ( hypotension ), weight loss, kidney failure, changes in mood and personality, and shock[en.wikipedia.org]
    Vomiting
    • Symptoms Patients usually present with anorexia, nausea and vomiting.[symptoma.com]
    • A patient who is vomiting may require injections of hydrocortisone instead.[en.wikipedia.org]
    • Addisonian patients may present with lethargy, diarrhea, vomiting, increased thirst, increased urination, and unplanned weight loss.[vcahospitals.com]
    • Get medical care for your child right away if he or she has vomiting or diarrhea or other illness.[urmc.rochester.edu]
    • Deficient production of both these hormones can cause a number of symptoms like weakness, dehydration , low blood pressure , depression, heart toxicity, vomiting, blood in feces, and weight loss.[petmd.com]
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  • musculoskeletal
    Muscle Cramp
    • They can also occur... read more » Leg cramps at night a classic sign : The symptom of having leg muscle cramps, particularly at night, is a classic sign of undiagnosed diabetes .[rightdiagnosis.com]
    Muscle Weakness
    • Symptoms include • Weight loss • Muscle weakness • Fatigue that gets worse over time • Low blood pressure • Patchy or dark skin Lab tests can confirm that you have Addison disease.[youtube.com]
    • Symptoms of Addison's disease begin gradually and include chronic, worsening fatigue , muscle weakness, loss of appetite , and weight loss .[medicinenet.com]
    • Pain in the hind quarters, or generalized muscle weakeness such as a dog that can't jump onto a bed or couch as he has done in the past is not uncommon.[addisondogs.com]
    • Symptoms include Weight loss Muscle weakness Fatigue that gets worse over time Low blood pressure Patchy or dark skin Lab tests can confirm that you have Addison disease.[fpnotebook.com]
    • Symptoms may include muscle weakness, fatigue, and dizziness.[urmc.rochester.edu]
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  • cardiovascular
    Orthostatic Hypotension
    • Normal hydration and absence of orthostatic hypotension are evidence of adequate replacement therapy.[merckmanuals.com]
    • On physical examination, these clinical signs may be noticed: Low blood pressure with or without orthostatic hypotension (blood pressure that decreases with standing) Darkening (hyperpigmentation) of the skin, including areas not exposed to the sun.[en.wikipedia.org]
    • Additional signs and symptoms include weakness, tiredness, dizziness, low blood pressure that falls further when standing ( orthostatic hypotension ), cardiovascular collapse , muscle aches , nausea , vomiting , and diarrhea .[en.wikipedia.org]
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  • urogenital
    Amenorrhea
    • See full list of 8 diagnostic tests for Addison's Disease Addison's Disease: Complications Review possible medical complications related to Addison's Disease: Addisonian crisis - the most dangerous outcome Salt loss Irritability Depression Amenorrhea[rightdiagnosis.com]
    • Measuring serum calcium, phosphorus, glucose and thyrotropin Measure serum PTH if patient has hypocalcemia Hypogonadism should be investigated in post-menarchal female adolescents presenting in oligomenorrhea or amenorrhea by measuring FSH and LH.[pedclerk.bsd.uchicago.edu]
    • ., amenorrhea, flushing, fatigue, poor concentration). 34 It is appropriate to offer these patients evaluation and counseling on other options for building a family. 35 Enlarge Print Table 4.[aafp.org]
    Oligomenorrhea
    • Measuring serum calcium, phosphorus, glucose and thyrotropin Measure serum PTH if patient has hypocalcemia Hypogonadism should be investigated in post-menarchal female adolescents presenting in oligomenorrhea or amenorrhea by measuring FSH and LH.[pedclerk.bsd.uchicago.edu]
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  • psychiatrical
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  • Ears
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  • Workup

    Addison’s disease is primarily investigated by means of an extensive clinical history taking followed by a careful review of the presenting signs and symptoms. When the patients are suspected of having Addison’s disease the following confirmatory tests may be done to ascertain the diagnosis:

    • Serum electrolytes: This blood test will determine the present level of sodium and potassium in the serum because these electrolytes are usually affected in Addison’s disease.
    • Hormonal assays: The hormonal levels of ACTH and cortisol are likewise determined to support the suspicion of Addison’s disease.
    • ACTH stimulation test: This hormonal test monitors the level of cortisol produced in the body after the injection of a synthetic ACTH hormone [8]. A damaged adrenal cortex may not respond to ACTH stimulation at all.
    • Insulin-induced hypoglycemia test: This will test for secondary adrenal insufficiency or those caused by a pituitary dysfunction. This test measures the levels of blood glucose and cortisol levels at the different time intervals after the introduction of synthetic insulin. The normal response of the body is to decrease the glucose level and increase the cortisol level.
    • Imaging: Computed tomography (CT scan) of the abdomen can elucidate the size and pathology of the adrenal gland at the suprarenal region [9]. Magnetic resonance imaging (MRI) may demonstrate the conditions of the pituitary gland in the skull to rule out secondary causes of adrenal insufficiency.

    Pathology

    Biopsy
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  • Test Results

    Other Test Results
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  • Laboratory

    Serum
    Eosinophils Increased
    • 135 mEq/L Serum potassium 5 mEq/L Ratio of serum sodium:potassium 30:1 Plasma glucose, fasting 50 mg/dL ( 2.78 mmol/L) Plasma bicarbonate 15–20 mEq/L BUN 20 mg/dL ( 7.1 mmol/L) Hematology Hct Elevated WBC count Low Lymphocytes Relative lymphocytosis Eosinophils[merckmanuals.com]
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  • Urine
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  • ECG

    QT, RR, ST Intervals
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  • Other ECG Findings
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  • Imaging

    X-ray
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  • Treatment

    The main goal in the treatment of Addison’s disease is to replace the deficient hormones in the right levels of steroid hormones that the adrenal glands are incapable of maintaining. The following are options used in the treatment of Addison’s disease:

    • Oral corticosteroids: Patients may be given oral hydrocortisone, prednisone, or cortisone acetate to replace the deficient cortisol hormone. In the same way, fludrocortisone may be given to replace the aldosterone deficiency.
    • Injectable corticosteroids: This steroid is given for the same indications. This option is resorted by patients if they are unable to tolerate oral corticosteroids [10].
    • Androgen replacement therapy: This regimen is given to women with low androgen levels. The oral dehydroepiandrosterone is preferentially used to address problems of libido and sexual satisfaction in women.
    • Sodium supplementations: Sodium may be amply given during activities that incurs heavy perspiration like exercises. Excessive diarrhea and vomiting among patients may also benefit from the sodium supplementations.

    Prognosis

    Addison’s disease presenting with significant adrenal hormone insufficiency can be life threatening if left untreated. Patients undergoing hormone replacement therapy with the deficient mineralocorticoid and glucocorticoid may live a normal life.

    Complications

    Acidosis
    • Signs and symptoms include low blood pressure, nausea and vomiting, syncope, hypoglycemia, hyponatremia, hyperkalemia, a metabolic acidosis, lethergy, confusion, and convulsions.[openanesthesia.org]
    • Mitochondrial DNA mutations May also cause AI and are characterized by chronic lactic acidosis, myopathy, cataracts, and nerve deafness Presentation It is important to consider the diagnosis of Addison’s with any of the following signs and symptoms, as[pedclerk.bsd.uchicago.edu]
    • A mild to moderate metabolic acidosis also may occur because lack of aldosterone impairs renal tubular hydrogen ion secretion.[veterinarynews.dvm360.com]
    • Eosinophilia and lymphocytosis (increased number of eosinophils or lymphocytes, two types of white blood cells) Metabolic acidosis (increased blood acidity), also is due to loss of the hormone aldosterone because sodium reabsorption in the distal tubule[en.wikipedia.org]
    • There is often times metabolic acidosis.[earthclinic.com]
    Addison's Disease
    • Addison’s disease is relatively rare internationally.[symptoma.com]
    • Addison's disease at DMOZ[en.wikipedia.org]
    • Recently diagnosed with Addison's disease Severe adrenal rushes Addison's Disease Addison's Disease: Deaths Read more about Deaths and Addison's Disease .[rightdiagnosis.com]
    • Signs and symptoms of Addison's disease Causes Of Addison's disease Diagnosing Addison's disease Treatment options for Addison's disease[medicalnewstoday.com]
    • International The occurrence of Addison disease is rare.[emedicine.medscape.com]
    Addisonian Crisis
    Adrenocortical Insufficiency
    • , Insufficiency, Primary Adrenocortical , Primary Adrenal Insufficiency , Primary Adrenocortical Insufficiencies , Primary Adrenocortical Insufficiency , Primary Hypoadrenalism , Adrenal Insufficiency, Primary , Adrenocortical Insufficiencies, Primary[fpnotebook.com]
    • Also called bronzed disease , chronic adrenocortical insufficiency .[dictionary.reference.com]
    • Addison's disease is also called primary adrenocortical insufficiency.[encyclopedia.com]
    • This may be provoked either de novo, such as by adrenal hemorrhage, or in the setting of an acute event superimposed on chronic or inadequately treated adrenocortical insufficiency.[emedicine.medscape.com]
    • Alternative Titles: adrenal cortical insufficiency, adrenocortical hypofunction, hypocortisonism, primary adrenocortical insufficiency Addison disease , also called hypocortisolism or adrenal insufficiency , rare disorder defined by destruction of the[britannica.com]
    Alopecia
    • […] observed in dogs: Lethargy Lack of appetite (anorexia) Vomiting Weight loss Diarrhea Shaking Increased frequency of urination ( polyuria ) Increased thirst ( polydipsia ) Depression Dehydration Weak pulse Collapse Low temperature Blood in feces Hair loss (alopecia[petmd.com]
    • […] usually presented by patients with primary adrenal insufficiency: Anorexia Weight loss Fatigue Muscular weakness Hyperpigmentation Hypotension Syncope Hypoglycemia Salt cravings Nausea and vomiting Diarrhea Myositis and arthritis Irritability  Depression Alopecia[symptoma.com]
    • Autoimmune thyroid disease • TSH; check free T4 and anti TPO antibodies if TSH outside reference range Type 1 diabetes • Fasting glucose/HbA1c Autoimmune parathyroid disease • Bone profile — check PTH if low calcium Vitiligo • Physical examination only Alopecia[bjgp.org]
    Anxiety
    • These changes are often accompanied by mood disorders such as anxiety and depression.[lifeextension.com]
    • Symptoms include: fatigue muscle weakness joint or muscle pain fever weight loss nausea , vomiting , and or diarrhea (leading to dehydration ) headache sweating changes in mood or personality, such as irritability, anxiety , or depression loss of appetite[familydoctor.org]
    • In summary, diagnostic pitfalls to be aware of include a chronic presentation which may be misdiagnosed as one of a number of other problems, often based on a mental health diagnosis, for example anxiety or depression; precipitation into crisis through[bjgp.org]
    • The Travell records reveal that Boles prescribed one milligram twice a day of Stelazine, an anti-psychotic that was also used as a treatment for anxiety.[theatlantic.com]
    • The signs and symptoms include fatigue; lightheadedness upon standing or difficulty standing, muscle weakness, fever, weight loss, anxiety, nausea, vomiting, diarrhea, headache, sweating, changes in mood or personality, and joint and muscle pains.[en.wikipedia.org]
    Constipation
    • Signs and symptoms include weakness, weight loss, joint pain, postural hypotension, headache, anorexia, constipation, diarrhea, hyperpigmentation, hyponatremia, hyperkalemia, hypoglycemia, and hypercalcemia.[openanesthesia.org]
    • Diarrhoea or constipation which may come and go.[patient.info]
    • I knew all this vomiting, alternating diarrhea and constipation, and other symptoms weren’t normal.”[whole-dog-journal.com]
    • ., nausea, vomiting, abdominal pain, constipation, diarrhea) 92 Hypotension (systolic blood pressure 110 mm Hg) 90 Salt cravings 16 Postural dizziness 12 Vitiligo 10 to 20 Muscle or joint pain 10 Hyperpigmentation is the physical finding most characteristic[aafp.org]
    Dehydration
    • Deficient production of both these hormones can cause a number of symptoms like weakness, dehydration , low blood pressure , depression, heart toxicity, vomiting, blood in feces, and weight loss.[petmd.com]
    • Loss of water, in vomit and diarrhea, can lead to dehydration.[vetmed.wsu.edu]
    • Severe dehydration and a low sodium level reduce blood volume and can lead to shock .[merckmanuals.com]
    • Other symptoms include weight loss, nausea, loss of appetite, salt cravings, and dehydration.[sharecare.com]
    • Clinical pathology Complete blood count may reveal a nonregenerative normocytic normochromic anemia, or the hematocrit may be increased due to dehydration.[veterinarynews.dvm360.com]
    Depression
    • Common misdiagnoses include depression or ... read more » Cushing's disease can be mistaken for depression : Cushing's disease (or similarly Cushing's syndrome ) is a possible misdiagnosis for a person diagnosed with depression .[rightdiagnosis.com]
    • Deficient production of both these hormones can cause a number of symptoms like weakness, dehydration , low blood pressure , depression, heart toxicity, vomiting, blood in feces, and weight loss.[petmd.com]
    • On examination of dogs with Addison’s disease one may see depression, weakness, dehydration, weak pulses and sometimes a slow, irregular heart rate.[vetmed.wsu.edu]
    • Common symptoms include: weakness fatigue abdominal pain nausea weight loss low blood pressure darkened skin (in the case of Addison’s disease) salt craving (in the case of Addison’s disease) dizziness upon standing depression However, there are different[endocrineweb.com]
    • There is also depressed thyroid function: sensitivity to cold, slowness in mental and physical activities, loss of sexual libido, absence of menstruation in women and impotence in men.[herballegacy.com]
    Eosinophilia
    • Eosinophilia, neutrophilia or lymphocytosis occurs in only 20 percent to 30 percent of dogs with hypoadrenocorticism, but lack of a stress leukogram in a dog with systemic illness is common.[veterinarynews.dvm360.com]
    • Eosinophilia and lymphocytosis (increased number of eosinophils or lymphocytes, two types of white blood cells) Metabolic acidosis (increased blood acidity), also is due to loss of the hormone aldosterone because sodium reabsorption in the distal tubule[en.wikipedia.org]
    Hashimoto's Thyroiditis
    • Addison's disease is associated with the development of other autoimmune diseases, such as type I diabetes, thyroid disease (Hashimoto's thyroiditis), celiac disease, or vitiligo.[en.wikipedia.org]
    • thyroiditis , and Hashimoto's disease). [12] Hypogonadism may also present with this syndrome.[en.wikipedia.org]
    Hyperkalemia
    • Preparation of such a patient for surgery should include treatment of hypovolemia, hyperkalemia, and hyponatremia .[openanesthesia.org]
    • Hyponatremia and hyperkalemia may also result form chronic renal insufficiency.[pedclerk.bsd.uchicago.edu]
    • In a retrospective study of dogs with hypoadrenocorticism, 24 percent lacked hyponatremia and hyperkalemia.[veterinarynews.dvm360.com]
    • Most patients with the condition have deficiencies in aldosterone and cortisol and therefore have decreased serum sodium concentrations (hyponatremia) and increased serum potassium concentrations (hyperkalemia).[britannica.com]
    • Hyperkalemia (raised blood potassium levels), due to loss of production of the hormone aldosterone.[en.wikipedia.org]
    Hypoglycemia
    • Signs of hypotension and hypoglycemia may also be observable.[symptoma.com]
    • Signs and symptoms include low blood pressure, nausea and vomiting, syncope, hypoglycemia, hyponatremia, hyperkalemia, a metabolic acidosis, lethergy, confusion, and convulsions.[openanesthesia.org]
    • Hypoglycemia often is overlooked as a possible presentation of primary adrenal insufficiency.[endocrinologyadvisor.com]
    • Other findings include lower levels of sodium (hyponatremia) and chloride (hypochloremia), increased levels of calcium (hypercalcemia), increased liver enzymes, including ALT and AST, and low blood sugar ( hypoglycemia ).[petmd.com]
    Hyponatremia
    • Preparation of such a patient for surgery should include treatment of hypovolemia, hyperkalemia, and hyponatremia .[openanesthesia.org]
    • Hyponatremia also is often not investigated further for existing primary adrenal insufficiency before making a diagnosis of SIADH (syndrome of inappropriate antidiuretic hormone).”[endocrinologyadvisor.com]
    • In a retrospective study of dogs with hypoadrenocorticism, 24 percent lacked hyponatremia and hyperkalemia.[veterinarynews.dvm360.com]
    • Hyponatremia and hyperkalemia may also result form chronic renal insufficiency.[pedclerk.bsd.uchicago.edu]
    • Other findings include lower levels of sodium (hyponatremia) and chloride (hypochloremia), increased levels of calcium (hypercalcemia), increased liver enzymes, including ALT and AST, and low blood sugar ( hypoglycemia ).[petmd.com]
    Hypotension
    • Signs of hypotension and hypoglycemia may also be observable.[symptoma.com]
    • Weight loss, dehydration, and hypotension are characteristic of the later stages of Addison disease.[merckmanuals.com]
    • “In order to accomplish this, we need to increase our awareness for the disease and add primary adrenal insufficiency early to the list of differential diagnosis in severely ill patients with particular symptoms and signs like hypotension, hyponatremia[endocrinologyadvisor.com]
    • Signs and symptoms include weakness, weight loss, joint pain, postural hypotension, headache, anorexia, constipation, diarrhea, hyperpigmentation, hyponatremia, hyperkalemia, hypoglycemia, and hypercalcemia.[openanesthesia.org]
    • The diagnosis was made following an acute admission due to features of an Addisonian crisis including hypotension, vomiting, debilitating fatigue, and hyperkalaemia.[bjgp.org]
    Hypovolemic Shock
    • If mineralocorticoids also are deficient, the clinical signs tend to be more severe, and polyuria, polydipsia, hypovolemic shock, collapse and dehydration often are present.[veterinarynews.dvm360.com]
    Metabolic Acidosis
    • Signs and symptoms include low blood pressure, nausea and vomiting, syncope, hypoglycemia, hyponatremia, hyperkalemia, a metabolic acidosis, lethergy, confusion, and convulsions.[openanesthesia.org]
    • A mild to moderate metabolic acidosis also may occur because lack of aldosterone impairs renal tubular hydrogen ion secretion.[veterinarynews.dvm360.com]
    • Eosinophilia and lymphocytosis (increased number of eosinophils or lymphocytes, two types of white blood cells) Metabolic acidosis (increased blood acidity), also is due to loss of the hormone aldosterone because sodium reabsorption in the distal tubule[en.wikipedia.org]
    • Patients with Addison’s Disease may present acutely in Addisonian crisis that involve sudden sharp leg pain, lower back or abdominal pain, nausea, vomiting, hyponatremic dehydration, hyperkalemia, metabolic acidosis, hypotension, hypoglycemia, shock or[pedclerk.bsd.uchicago.edu]
    • There is often times metabolic acidosis.[earthclinic.com]
    Prerenal Azotemia
    • Dehydration and low blood pressure cause blood filtration to drop, resulting in “prerenal azotemia,” where waste products build up even though the kidney itself is functioning.[whole-dog-journal.com]
    Psychosis
    • Nocturia (night urination) is common in patients with chronic adrenal deficiency, because of the impairment of their handling of a water load .... mild neurotic traits to gross psychosis ... depression, schizophrenia, and hallucinations .... severe headache[herballegacy.com]
    • […] are: Sudden penetrating pain in the legs, lower back, or abdomen Severe vomiting and diarrhea, resulting in dehydration Low blood pressure Syncope (loss of consciousness and ability to stand) Hypoglycemia (reduced level of blood glucose) Confusion, psychosis[en.wikipedia.org]
    Septicemia
    • Meningococcal septicemias can lead to bilateral adrenal hemorrhage, subsequently causing circulatory collapse (Waterhouse- Freidrichsen Syndrome) Chronic fungal, CMV, and HIV infections can lead to adrenal infiltration and subsequent adrenal failure X-linked[pedclerk.bsd.uchicago.edu]
    • Onset of severe symptoms (adrenal crisis) may be precipitated by acute infection (a common cause, especially with septicemia).[merckmanuals.com]
    Shock
    • Classically, veterinarians are presented with a young animal in shock.[veterinarypartner.com]
    • If left untreated, Addison's disease can cause severe abdominal pain, weakness, low blood pressure, kidney failure and shock.[childrenshospital.org]
    • The dog can collapse in shock and may not survive.[desertsun.com]
    • If mineralocorticoids also are deficient, the clinical signs tend to be more severe, and polyuria, polydipsia, hypovolemic shock, collapse and dehydration often are present.[veterinarynews.dvm360.com]
    • But if an Addisonian crisis is not treated, it can lead to: Shock Seizures Coma Living with adrenal insufficiency Take your medicine exactly as prescribed.[massgeneral.org]
    Syncope
    • Signs and symptoms include low blood pressure, nausea and vomiting, syncope, hypoglycemia, hyponatremia, hyperkalemia, a metabolic acidosis, lethergy, confusion, and convulsions.[openanesthesia.org]
    • The following signs and symptoms are usually presented by patients with primary adrenal insufficiency: Anorexia Weight loss Fatigue Muscular weakness Hyperpigmentation Hypotension Syncope Hypoglycemia Salt cravings Nausea and vomiting Diarrhea Myositis[symptoma.com]
    • Characteristic symptoms are: Sudden penetrating pain in the legs, lower back, or abdomen Severe vomiting and diarrhea, resulting in dehydration Low blood pressure Syncope (loss of consciousness and ability to stand) Hypoglycemia (reduced level of blood[en.wikipedia.org]
    • Dizziness and syncope may occur.[merckmanuals.com]
    Vitiligo
    • Patient with Addison’s disease on a background of vitiligo (face).[bjgp.org]
    • Some autoimmune disorders, such as vitiligo, increase the risk of Addison's disease.[medicalnewstoday.com]
    • It's not clear how these genes lead to Addison's disease and similar conditions, but it does mean your risk of developing Addison's disease is increased if you or a close family member have another autoimmune condition, such as: vitiligo – a chronic ([nhs.uk]
    • […] factors for the autoimmune type of Addison disease include other autoimmune diseases : Chronic thyroiditis Dermatis herpetiformis Graves' disease Hypoparathyroidism Hypopituitarism Myasthenia gravis Pernicious anemia Testicular dysfunction Type I diabetes Vitiligo[nytimes.com]
    • […] they control ( myasthenia gravis ) Body does not have enough healthy red blood cells ( pernicious anemia ) Testicles cannot produce sperm or male hormones ( testicular failure ) Type I diabetes Loss of brown color (pigment) from areas of the skin ( vitiligo[nlm.nih.gov]
  • more...
  • Etiology

    The greater majority of cases of Addison’s disease or primary adrenal insufficiency is caused by the idiopathic atrophy of the adrenals, accounting for almost 70% of all cases. The leading theory postulated for the idiopathic atrophy of the adrenals points to an autoimmune origin. There are however, some less common causes of adrenal destruction which include granuloma, tuberculosis, histoplasmosis, amyloidosis, inflammatory necrosis, hemorrhage and tumorous growths. The most common cause of Addison’s disease among children is congenital adrenal hyperplasia (CAH).

    Epidemiology

    In the United States, the recent prevalence rate of Addison’s disease is up to 60 cases per one million population. Addison’s disease is relatively rare internationally. The increase in the mortality and morbidity rates is usually due to the delay in the replacement therapy of the mineralocorticoid and glucocorticoid hormones [2]. Although, primary adrenal insufficiency is already considered serious and potentially life threatening, concomitant illnesses like malignancies, cardiovascular diseases, and infectious diseases influences greatly the increased mortality rate among these patients [3].

    The primary idiopathic and autoimmune form of Addison’s disease is more commonly seen in children and females. There is no racial predilection to Addison’s disease. The mean age of onset is 30 to 50 years old but may present earlier among the infantile cases of congenital adrenal hyperplasia.

    Sex distribution
    Age distribution

    Pathophysiology

    The pathogenesis of Addison’s disease or adrenal insufficiency is primarily due to the destruction of the adrenal cortex. Cortical destruction may either be inflammatory, necrotic, neoplastic, infectious, or hemorrhagic in nature. Signs and symptoms of adrenal insufficient usually present clinically when 90% or more of the adrenal cortex has been rendered dysfunctional or destroyed. The main systemic pathology is brought about by the lack of glucocorticoid and mineralocorticoid hormone secretion that is essential to the body.

    Prevention

    The congenital form of primary adrenal insufficiency cannot be prevented, although; new born screening may detect congenital adrenal hyperplasia in the first two days of life. The prompt diagnosis and hormone replacement therapy of Addison’s disease can prevent untoward complications and death.

    Summary

    Addison’s disease is a serious disorder that occurs when the adrenal glands are unable to produce sufficient hormones needed for proper metabolism. In this disorder, the hormones aldosterone and cortisol are insufficiently secreted from the suprarenal glands. For this reason, Addison’s disease is also referred to as primary adrenal insufficiency [1]. Hormonal treatment is the standard approach to this disease to mimic the natural function of the deficient adrenal hormone.

    Patient Information

    Definition

    Addison’s disease is a serious disorder that occurs when the adrenal glands is unable to produce sufficient mineralocorticoid and glucocorticoid hormones needed for normal functioning.

    Cause

    The most common cause of Addison’s disease is idiopathic autoimmune adrenal atrophy. The other causes include granuloma, tuberculosis, histoplasmosis, amyloidosis, inflammatory necrosis, hemorrhage and tumors.

    Symptoms

    Patients usually present with anorexia, nausea and vomiting. Muscular fatigue and weakness are fairly common with hyperpigmentation of the skin. Signs of hypotension and hypoglycemia may also be observable.

    Diagnosis

    Diagnostics for Addison’s disease starts with blood test of electrolytes and hormones. ACTH stimulation tests and Insulin-induced hypoglycemia tests, imaging studies with CT scan and MRI may follow.

    Treatment and follow-up

    The cornerstone in the treatment of Addison’s disease is the active hormonal replacement of the deficient hormones. Glucocorticoids are replaced with oral and injectable steroids, mineralocorticoids are replace by fludrocortisone. Androgen replacement therapy for afflicted women can allay the signs of androgen deficiency.

    Self-assessment

    References

    1. Addison T. On the Constitutional and Local Effects of Disease of the Supra-renal Capsules. London, UK: Samuel Highley; 1855.
    2. White K, Arlt W. Adrenal crisis in treated Addison's disease: a predictable but under-managed event. Eur J Endocrinol. Jan 2010; 162(1):115-20.
    3. Kyriazopoulou V. Glucocorticoid replacement therapy in patients with Addison's disease. Expert Opin Pharmacother. Apr 2007; 8(6):725-9.
    4. Bergthorsdottir R, Leonsson-Zachrisson M, Oden A, et al. Premature mortality in patients with Addison's disease: a population-based study. J Clin Endocrinol Metab. Dec 2006; 91(12):4849-53.
    5. McBrien DJ. Steatorrhea in Addison's disease. Lancet. 1963; Vol I: 25-6.
    6. Barnett AH, Espiner EA, Donald RA. Patients presenting with Addison's disease need not be pigmented.Postgrad Med J. Nov 1982; 58(685):690-2.
    7. McBrien DJ. Steatorrhea in Addison's disease. Lancet. 1963; Vol I: 25-6.
    8. Kyriazopoulou V, Parparousi O, Vagenakis AG. Rifampicin-induced adrenal crisis in addisonian patients receiving corticosteroid replacement therapy. J Clin Endocrinol Metab. Dec 1984; 59(6):1204-6.
    9. Likhari T, Magzoub S, Griffiths MJ, et al. Screening for Addison's disease in patients with type 1 diabetes mellitus and recurrent hypoglycaemia. Postgrad Med J. Jun 2007; 83(980):420-1.
    10. Ma ES, Yang ZG, Li Y, et al. Tuberculous Addison's disease: morphological and quantitative evaluation with multidetector-row CT. Eur J Radiol. Jun 2007; 62(3):352-8.

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    Media References

    1. Addisons hyperpigmentation, CC0 1.0

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