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Page: Addison's Disease
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In primary adrenal insufficiency (classic Addison's disease) the hormone aldosterone is also deficient. Many of the symptoms of Addison's disease arise due to the hyposecretion of aldosterone leading to hyperkalemia (high blood potassium levels) and metabolic acidosis (increased acidity of the blood due to decreased bicarbonate levels). Often the production of adrenaline is also diminished.
Treatment is with replacement of the hormones (oral hydrocortisone and fludrocortisone). If the disease is caused by an underlying problem, this is addressed. Regular follow-up and monitoring for other health problems is necessary.
Addison's disease usually affects the body slowly (over several months). The symptoms tend to be non-specific, and may not be noticed until some stressful intercurrent illness or situation occurs. Common symptoms are:
* Chronic fatigue that gradually worsens
* Muscle weakness
* Weight loss and loss of appetite
* Nausea, diarrhea, or vomiting
* Areas of hyperpigmentation (darkened skin), known as melasma suprarenale, caused by increases in pro-opiomelanocortin. Although cutaneous pigmentation will most likely disappear following therapy, pigmentation of the oral mucosa tends to persist.
* Irritability
* Depression
* Craving for salt and salty foods
* Polyuria (increased urine production)
* For women, menstrual periods that become irregular or cease
On examination, the following may be noticed:
* Low blood pressure that falls further when standing (orthostatic hypotension)
* Tetany (particularly after drinking milk) due to phosphate excess
* Numbness of the extremities, sometimes with paralysis, due to potassium excess
* Hypovolemia (decreased blood volume)
* Dehydration
* Hypotension (abnormally low blood pressure)
* Tremors
* Tachycardia (abnormally rapid beating of the heart)
* Restlessness
* Diaphoresis (excessive sweating)
* Axillary or pubic hypotrichosis (decreased hair growth)
Routine investigations may show:
* Hypoglycemia, low blood sugar (worse in children)
* Eosinophilia (increased number of eosinophils, a type of white blood cells)
* Hyponatraemia (low blood sodium levels), possibly worsened by loss of production of the hormone aldosterone, but occurs in secondary (pituitary) adrenal insufficiency as well. This underscores the point that the hyponatremia is primarily due to cortisol deficiency per se. Such deficiency causes poor vascular tone and decreased cardiac output, thereby leading to an (effective) decrease in blood volume thus stimulating ADH secretion..
* Hyperkalemia (raised blood potassium levels), due to loss of production of the hormone aldosterone.
Addisonian crisis
In some cases, Addison's symptoms may present rapidly. This "acute adrenal failure" is known as an Addisonian crisis and is a severe medical emergency. An illness or accident can aggravate the adrenal problems causing the Addisonian crisis (most common in untreated sufferers), although the most common cause (for those already diagnosed) is abrupt discontinuation of corticosteroid therapy without tapering the dose. Untreated, an Addisonian crisis can be fatal. It is a medical emergency, usually requiring hospitalization.
Symptoms that may occur include:
* Sudden penetrating pain in the legs, lower back or abdomen
* Severe vomiting and diarrhea, resulting in dehydration
* Low blood pressure
* Loss of consciousness/Syncope
* Hypoglycemia
* Confusion, psychosis
* Convulsions
Addisonian episode
An Addisonian episode is a less acute and less severe event than an Addisonian crisis and may consist of anorexia, nausea, vomiting, diarrhea, dehydration, weakness, or a combination of symptoms. Unlike the more advanced Addisonian crisis, it may be treated without hospitalization to prevent the onset of full crisis.
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Important notice:
The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other
qualified health provider with any questions you may have regarding a medical condition.
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