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Addison's Disease

Addisons Disease

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.


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:

Fatigue
  • Forty-eight per cent of patients showed abnormal fatigue, while 61% had severe fatigue. The CIS fatigue scores were significantly higher compared to controls (P 0·01).[ncbi.nlm.nih.gov]
  • The patient noted a marked symptomatic improvement in morning symptoms, but with persistent fatigue during the day.[ncbi.nlm.nih.gov]
  • On follow-up visits within the following year, fatigue had diminished and there was no evidence of progressive neurological deficits. However, exacerbation of the psychiatric symptomatology resulted in admittance to a psychiatric ward.[ncbi.nlm.nih.gov]
  • Herein, we describe the case of a 50-year-old gentleman residing in western Sudan who presented with a 7-month history of generalized body weakness, easy fatigue, and frequent attacks of vomiting and diarrhea.[ncbi.nlm.nih.gov]
  • Health Diseases Adrenal Fatigue Addison’s Disease and Adrenal Fatigue Adrenal insufficiency, also known as Addison’s disease, is an autoimmune condition. Though the features overlap, it is different than adrenal fatigue.[dummies.com]
Weakness
  • Herein, we describe the case of a 50-year-old gentleman residing in western Sudan who presented with a 7-month history of generalized body weakness, easy fatigue, and frequent attacks of vomiting and diarrhea.[ncbi.nlm.nih.gov]
  • Abstract A young Marshallese woman presented with the insidious development of fever, cough, fatigue, profound weakness, massive weight loss, cachexia, alopecia, amenorrhea, and periumbilical hyperpigmentation.[ncbi.nlm.nih.gov]
  • Classically, patients affected with Addison's disease develop weakness, anorexia, electrolyte imbalances: decreased sodium and chloride with increased serum potassium resulting in hypotension, and hyperpigmentation of the skin and mucous membranes.[ncbi.nlm.nih.gov]
  • Abstract Primary adrenal insufficiency or Addison's disease is a rare disorder often difficult to diagnose on presentation by the nature of its associated nonspecific symptoms, such as nausea or weakness.[ncbi.nlm.nih.gov]
  • The physical examination was completely normal except for muscle weakness, hyperpigmentation on labial mucosa and skin in a patient. The laboratory tests revealed anemia and hypoglycemia.[ncbi.nlm.nih.gov]
Weight Loss
  • On review of history, the cause of vomiting and weight loss was questioned and combined with subsequent biochemical testing a diagnosis of Addison's disease was made.[ncbi.nlm.nih.gov]
  • A 32-year-old Caucasian was admitted at 14 weeks of gestation with hypotension and weight loss.[ncbi.nlm.nih.gov]
  • Hyperpigmentation was observed in 76%, nausea and vomiting occurred in more than 40%, and weight loss was noted in 25%.[ncbi.nlm.nih.gov]
  • Orthostatic hypotension, fever, and hypoglycemia characterize acute adrenal crisis, whereas chronic primary adrenal insufficiency presents with a more insidious history of malaise, anorexia, diarrhea, weight loss, joint, and back pain.[ncbi.nlm.nih.gov]
  • Abstract A young Marshallese woman presented with the insidious development of fever, cough, fatigue, profound weakness, massive weight loss, cachexia, alopecia, amenorrhea, and periumbilical hyperpigmentation.[ncbi.nlm.nih.gov]
Fever
  • Orthostatic hypotension, fever, and hypoglycemia characterize acute adrenal crisis, whereas chronic primary adrenal insufficiency presents with a more insidious history of malaise, anorexia, diarrhea, weight loss, joint, and back pain.[ncbi.nlm.nih.gov]
  • Abstract A young Marshallese woman presented with the insidious development of fever, cough, fatigue, profound weakness, massive weight loss, cachexia, alopecia, amenorrhea, and periumbilical hyperpigmentation.[ncbi.nlm.nih.gov]
  • CASE: A 39-yr-old male was referred because of extreme fatigue, weight loss, anorexia, nausea, and bouts of fever. During physical examination hyperpigmentation was seen. Laboratory tests showed a plasma cortisol of 0.02 micromol/l (08:30 h).[ncbi.nlm.nih.gov]
  • This cyclic pattern of fever, known as the Pel-Ebstein fever, is “a classic clinical sign in Hodgkin’s disease. ..[mh.bmj.com]
Anorexia
  • Orthostatic hypotension, fever, and hypoglycemia characterize acute adrenal crisis, whereas chronic primary adrenal insufficiency presents with a more insidious history of malaise, anorexia, diarrhea, weight loss, joint, and back pain.[ncbi.nlm.nih.gov]
  • Classically, patients affected with Addison's disease develop weakness, anorexia, electrolyte imbalances: decreased sodium and chloride with increased serum potassium resulting in hypotension, and hyperpigmentation of the skin and mucous membranes.[ncbi.nlm.nih.gov]
  • The clinical manifestations before an adrenal crisis are subtle and can include hyperpigmentation, fatigue, anorexia, orthostasis, nausea, muscle and joint pain, and salt craving.[ncbi.nlm.nih.gov]
  • Medicine, Postfach, Münsterlingen, 8596, Switzerland. [email protected] Abstract We report the case of a young man with a history of attention deficit/hyperactivity disorder and mild cognitive impairment who presented with chronic fatigue, anorexia[ncbi.nlm.nih.gov]
  • CASE: A 39-yr-old male was referred because of extreme fatigue, weight loss, anorexia, nausea, and bouts of fever. During physical examination hyperpigmentation was seen. Laboratory tests showed a plasma cortisol of 0.02 micromol/l (08:30 h).[ncbi.nlm.nih.gov]
Vomiting
  • On review of history, the cause of vomiting and weight loss was questioned and combined with subsequent biochemical testing a diagnosis of Addison's disease was made.[ncbi.nlm.nih.gov]
  • At about 8 weeks of gestation she started to vomit several times a day. She was treated with antiemetics and intravenous fluids. Following discharge she remained nauseated, weak and lightheaded and lost about 8 kg of weight.[ncbi.nlm.nih.gov]
  • Hyperpigmentation was observed in 76%, nausea and vomiting occurred in more than 40%, and weight loss was noted in 25%.[ncbi.nlm.nih.gov]
  • After initial improvement with antimicrobial therapy, new symptoms appeared, consisting of persistent vomits, abdominal pain and hypotension, which led to the diagnosis of Addison's disease.[ncbi.nlm.nih.gov]
  • Herein, we describe the case of a 50-year-old gentleman residing in western Sudan who presented with a 7-month history of generalized body weakness, easy fatigue, and frequent attacks of vomiting and diarrhea.[ncbi.nlm.nih.gov]
Nausea
  • Hyperpigmentation was observed in 76%, nausea and vomiting occurred in more than 40%, and weight loss was noted in 25%.[ncbi.nlm.nih.gov]
  • Abstract Primary adrenal insufficiency or Addison's disease is a rare disorder often difficult to diagnose on presentation by the nature of its associated nonspecific symptoms, such as nausea or weakness.[ncbi.nlm.nih.gov]
  • The clinical manifestations before an adrenal crisis are subtle and can include hyperpigmentation, fatigue, anorexia, orthostasis, nausea, muscle and joint pain, and salt craving.[ncbi.nlm.nih.gov]
  • We present a 51-year-old male patient, who underwent hemodialysis therapy for 8 years, diagnosed with Addison's disease after having myalgia, skin hyperpigmentation, weight loss, sweating, and nausea for the past few weeks.[ncbi.nlm.nih.gov]
  • RESULT: A 48 years old male presented in our medical outpatient department with a three day history of sudden onset of severe precordial chest pain that started while playing football which was associated with nausea, vomiting and difficulty in breathing[ncbi.nlm.nih.gov]
Diarrhea
  • Herein, we describe the case of a 50-year-old gentleman residing in western Sudan who presented with a 7-month history of generalized body weakness, easy fatigue, and frequent attacks of vomiting and diarrhea.[ncbi.nlm.nih.gov]
  • Orthostatic hypotension, fever, and hypoglycemia characterize acute adrenal crisis, whereas chronic primary adrenal insufficiency presents with a more insidious history of malaise, anorexia, diarrhea, weight loss, joint, and back pain.[ncbi.nlm.nih.gov]
  • Excessive diarrhea and vomiting among patients may also benefit from the sodium supplementations. Addison’s disease presenting with significant adrenal hormone insufficiency can be life threatening if left untreated.[symptoma.com]
  • Get medical care for your child right away if he or she has vomiting or diarrhea or other illness.[urmc.rochester.edu]
  • Severe vomiting and diarrhea. Sudden, deep pain in the lower back, belly, or legs. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission.[my.clevelandclinic.org]
Abdominal Pain
  • After initial improvement with antimicrobial therapy, new symptoms appeared, consisting of persistent vomits, abdominal pain and hypotension, which led to the diagnosis of Addison's disease.[ncbi.nlm.nih.gov]
  • Symptoms and Causes The most common symptoms are fatigue, muscle weakness, loss of appetite, weight loss, and abdominal pain.[endocrine.niddk.nih.gov]
  • Seek emergency medical treatment if you experience the following signs and symptoms: Severe weakness Confusion Pain in your lower back or legs Severe abdominal pain, vomiting and diarrhea, leading to dehydration Reduced consciousness or delirium In an[mayoclinic.org]
Loss of Appetite
  • Symptoms and Causes The most common symptoms are fatigue, muscle weakness, loss of appetite, weight loss, and abdominal pain.[endocrine.niddk.nih.gov]
Oral Pigmentation
  • The patient presented with oral pigmented lesions, which were hypothesized to be mucosal pigmentation associated with Addison's disease.[ncbi.nlm.nih.gov]
Hypotension
  • As hypotension may be one of the few situations, in which NAAION may be treatable and the visual loss reversible, it is important to recognize and treat sustained episodes of hypotension in these individuals.[ncbi.nlm.nih.gov]
  • During admission for evaluation of hypotension, she was also detected to have hyponatremia. Hyponatremia and hypotension failed to improve despite fluid resuscitation.[ncbi.nlm.nih.gov]
  • After initial improvement with antimicrobial therapy, new symptoms appeared, consisting of persistent vomits, abdominal pain and hypotension, which led to the diagnosis of Addison's disease.[ncbi.nlm.nih.gov]
  • Orthostatic hypotension, fever, and hypoglycemia characterize acute adrenal crisis, whereas chronic primary adrenal insufficiency presents with a more insidious history of malaise, anorexia, diarrhea, weight loss, joint, and back pain.[ncbi.nlm.nih.gov]
  • Hypotension. Postural hypotension. Other situations which should provoke consideration of Addison's disease include: People with hypothyroidism in whom symptoms get worse when thyroxine treatment is commenced.[patient.info]
Orthostatic Hypotension
  • Orthostatic hypotension, fever, and hypoglycemia characterize acute adrenal crisis, whereas chronic primary adrenal insufficiency presents with a more insidious history of malaise, anorexia, diarrhea, weight loss, joint, and back pain.[ncbi.nlm.nih.gov]
  • Here are some key symptoms that can suggest Addison’s disease: When this condition first begins, you may experience fatigue, lightheadedness, and orthostatic hypotension (a drop in blood pressure when moving from lying down to either a sitting or standing[dummies.com]
  • Other symptoms include orthostatic hypotension (a drop in blood pressure when standing, which can cause dizziness or fainting) and skin changes.[diabetesselfmanagement.com]
  • hypotension ) darkening (hyperpigmentation) of the skin, in most cases, including areas not exposed to the sun (characteristic sites are skin creases (e.g. of the hands), nipples, and the inside of the cheek (buccal mucosa), also old scars may darken[web.archive.org]
Muscle Weakness
  • The physical examination was completely normal except for muscle weakness, hyperpigmentation on labial mucosa and skin in a patient. The laboratory tests revealed anemia and hypoglycemia.[ncbi.nlm.nih.gov]
  • Symptoms and Causes The most common symptoms are fatigue, muscle weakness, loss of appetite, weight loss, and abdominal pain.[endocrine.niddk.nih.gov]
  • A medical condition in which the adrenal glands do not produce enough cortisol or, in some cases, aldosterone, causing such problems as weight loss, muscle weakness, fatigue, low blood pressure, and sometimes darkened patches of skin.[diabetesselfmanagement.com]
Myalgia
  • We present a 51-year-old male patient, who underwent hemodialysis therapy for 8 years, diagnosed with Addison's disease after having myalgia, skin hyperpigmentation, weight loss, sweating, and nausea for the past few weeks.[ncbi.nlm.nih.gov]
  • Chronic Addison's disease Typically, chronic primary adrenal insufficiency has an insidious onset and presents with many non-specific symptoms and signs: - Weakness and fatigability (99%), anorexia (99%), nausea/vomiting, abdominal pain, myalgias/arthralgias[clinicaladvisor.com]
  • Myalgias and flaccid muscle paralysis may occur due to hyperkalemia. Patients may have a history of using medications known to affect adrenocortical function or to increase cortisol metabolism.[web.archive.org]
Muscle Cramp
  • Muscle cramps and joint pains. Syncope or dizziness (due to hypotension). Confusion. Personality change. Irritability. Loss of pubic or axillary hair in women, delayed puberty in children.[patient.info]
Arthralgia
  • Chronic Addison's disease Typically, chronic primary adrenal insufficiency has an insidious onset and presents with many non-specific symptoms and signs: - Weakness and fatigability (99%), anorexia (99%), nausea/vomiting, abdominal pain, myalgias/arthralgias[clinicaladvisor.com]
Hyperpigmentation
  • Herein this case report, we focus on the subtle findings of diffuse hyperpigmentation and intermittent but repetitive "flu-like" symptoms in two patients to correctly identify the diagnosis of Addison's disease effectively and efficiently.[ncbi.nlm.nih.gov]
  • KEYWORDS: Addison's disease; active tuberculosis; adrenal insufficiency; freckles; hyperpigmentation; pulmonary tuberculosis[ncbi.nlm.nih.gov]
  • The physical examination was completely normal except for muscle weakness, hyperpigmentation on labial mucosa and skin in a patient. The laboratory tests revealed anemia and hypoglycemia.[ncbi.nlm.nih.gov]
  • Hyperpigmentation was observed in 76%, nausea and vomiting occurred in more than 40%, and weight loss was noted in 25%.[ncbi.nlm.nih.gov]
  • An accident or illness can worsen the skin hyperpigmentation of Addison's disease.[emedicinehealth.com]
Alopecia
  • Abstract A young Marshallese woman presented with the insidious development of fever, cough, fatigue, profound weakness, massive weight loss, cachexia, alopecia, amenorrhea, and periumbilical hyperpigmentation.[ncbi.nlm.nih.gov]
  • […] 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]
  • Common autoimmune diseases associated with Addison’s Disease are: Chronic thyroiditis Graves’ disease Testicular dysfunction Hypopituitarism Hypoparathyroidism Type 1 diabetes Alopecia areata Hypogonadism Sjogren’s syndrome Vitiligo Pernicious anemia[dovemed.com]
Amenorrhea
  • Abstract A young Marshallese woman presented with the insidious development of fever, cough, fatigue, profound weakness, massive weight loss, cachexia, alopecia, amenorrhea, and periumbilical hyperpigmentation.[ncbi.nlm.nih.gov]
  • […] weakness Low blood pressure Dizziness Darkening of the skin and mucous membranes (hyperpigmentation) Nausea and vomiting Craving salt Headache Sweating Low blood sugar level Loss of interest in sex (decreased libido) Irregular or absent menstruation (amenorrhea[innerbody.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]
  • Steroid-responsive hyperprolactinemia may contribute to the impairment of gonadal function and to the amenorrhea.[web.archive.org]
  • ., amenorrhea, flushing, fatigue, poor concentration). 34 It is appropriate to offer these patients evaluation and counseling on other options for building a family. 35 View/Print Table Table 4.[web.archive.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]
Dizziness
  • She presented with a four-week history of decreased energy, malaise and postural dizziness. Our patient described an unusual diet of liquorice sticks and soy sauce, consuming around 46 g of salt per week.[ncbi.nlm.nih.gov]
  • Nine days before admission she had collapsed because of dizziness and had a cerebral concussion and open fracture of her nasal bone, however, no further investigations were carried out at that time.[ncbi.nlm.nih.gov]
  • 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[medlineplus.gov]
Asthenia
  • Adrenal crisis Adrenal crisis is characterized by Profound asthenia (weakness) 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]
Apathy
  • ., apathy, depression) Electrolyte abnormalities (hyponatremia, hyperkalemia, hypoglycemia) Neutropenia, eosinophilia B.[clinicaladvisor.com]

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.
Hyponatremia
  • During admission for evaluation of hypotension, she was also detected to have hyponatremia. Hyponatremia and hypotension failed to improve despite fluid resuscitation.[ncbi.nlm.nih.gov]
  • Based on the findings of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET), we had considered that the cause of the hyponatremia was syndrome of inappropriate secretion of antidiuretic hormone (SIADH) due to active extrapulmonary tuberculosis[ncbi.nlm.nih.gov]
  • Preparation of such a patient for surgery should include treatment of hypovolemia, hyperkalemia, and hyponatremia .[openanesthesia.org]
  • Limited laboratory studies revealed anemia, leukocytosis, and hyponatremia.[ncbi.nlm.nih.gov]
  • The patient also exhibited general fatigue, pigmentation, weight loss, hypotension and hyponatremia, suggestive of chronic adrenocortical insufficiency. An endocrine examination confirmed primary adrenocortical insufficiency.[ncbi.nlm.nih.gov]
Eosinophils Increased
  • Increased Imaging X-ray or CT Evidence of Calcification in adrenal area Renal TB Pulmonary TB Differential diagnosis Hyperpigmentation can result from bronchogenic carcinoma , ingestion of heavy metals (eg, iron, silver), chronic skin conditions, or[merckmanuals.com]

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.

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.

References

Article

  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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Last updated: 2018-06-22 07:49