Addison’s Disease

5 mins read

Introduction
Addison’s disease occurs due to insufficient production of hormones by the adrenal glands. These glands are located just above your kidneys. As a part of endocrinal system, they produce hormones that give instructions to virtually every organ and tissue in your body.

Adrenal gland is composed of an external part known as cortex and an inner part known as medulla. The cortex is responsible for production of three hormones that are extremely vital for life. Glucocorticoids including cortisol play an important role in regulation of sugar and body’s response to stress. Mineralocorticoids such as aldosterone maintain balance of sodium and potassium thereby, maintaining blood pressure. Sex hormones such as Androgens are produced by adrenal glands in both men and women. They are responsible for sexual development in men and play a role in muscle development in both men and women.

Causes
Addison’s disease is an outcome of damage to the adrenal cortex, which occurs due to low production of hormones. Adrenal insufficiency can also take place due to dysfunctional pituitary gland. The pituitary gland produces a hormone called adrenocorticotropic hormone (ACTH). In case of inadequate production of ACTH adrenal glands produce insufficient hormones. When asthma and arthritis patients suddenly stop taking corticosteroids, secondary adrenal insufficiency is said to occur.

This damage is likely to be caused due to following factors:

  • Attack of immune system on the adrenal glands (autoimmune disease)
  • Underlying infections such as tuberculosis, HIV, or fungal infections
  • Hemorrhage in the adrenal glands
  • Tumors

Symptoms
Addison’s disease manifests gradually over months and comprise of following:

  • Low blood sugar (hypoglycemia)
  • Nausea, diarrhea or vomiting
  • Sense of fatigue, reduced appetite and weight loss
  • Darkening of your skin (hyperpigmentation)
  • Longing for salty foods
  • Low blood pressure
  • Muscle weakness; Joint pains
  • Irritability and depression
  • Lesions on the inside of a cheek
  • Loss of body hair or sexual dysfunction in women

In Case Of Acute Adrenal Failure (Addisonian Crisis), Symptoms Show Up Immediately.
Symptoms of this development include pain in lower back, abdomen or legs; severe diarrhea, leading to dehydration; low blood pressure and hyperkalemia due to excess potassium.

Certain rare genetic defects may also cause adrenal insufficiency.

Diagnosis
Besides performing pressure check, patients of Addison’s disease need to undergo tests that check serum sodium, potassium and hormone levels.

With the help of blood test, doctor can ascertain cause of adrenal insufficiency by studying levels of sodium, potassium and cortisol. One can also know if any autoimmune condition is associated with Addison’s disease.

  • ACTH Stimulation Test.This test measures cortisol levels in blood before and after an injection of artificial ACTH. Test results showing limited or depleted levels of ACTH denote damage in adrenal glands.
  • Insulin-Induced Hypoglycemia Test. This test checks blood sugar (glucose) and cortisol levels in different time gaps after injecting insulin. In healthy bodies, cortisol levels are high and glucose levels are low.
  • Imaging Tests.Computerized tomography (CT) scan of abdomen is done to find out the size of adrenal glands and to know the cause of adrenal deficiency. While, MRI scan of pituitary gland can help in indicating secondary adrenal insufficiency.

Treatments And Drugs
Majority of treatments for curing Addison’s disease involves hormone replacement therapy to rectify steroid hormone levels in the body. Treatments include:

  • Oral corticosteroids containing fludrocortisone to replace aldosterone.
  • Corticosteroid injections are prescribed to those unable retain oral medications due to severe diarrhea.

Androgen replacement therapy corrects androgen deficiency in women by enhancing overall sense of well-being, libido and sexual satisfaction.

Complications arising due to imbalance of adrenal hormone include diabetes and thyroid complexities.

In case of adrenal crisis (low blood pressure and sugar condition), it is essential to inject hydrocortisone. It is recommended for patients of Addison disease to carry their medicines along with a medical card stating dosage of medicines. This can help them in case of emergency. During warm weather, sufficient amount of sodium intake is recommended to replenish its levels following fluid loss in the body.

Alternative Medicine
Adaptogenic herbs such as green tea, turmeric, reishi mushroom, Siberian ginseng, echinacea, milk thistle extract and ashwagandha may aid in relieving symptoms of Addison’s disease. Ginseng helps in preventing auto-immune diseases. Green Tea helps in regulating hormones, provides antioxidants and boosts immune system of the body. Turmeric, a known anti-inflammatory medicine also improves hormonal levels and counters negative effects of decrease in hormone production. These supplements can be taken along with prescribed medications for Addison ’s disease.

Intake of Immune-boosting foods such as citrus fruits, and also foods with high amount of antioxidants prevent the disease from worsening. Maintaining a proper diet and active exercise regimen is the best way to heal a body.

Homeopathic Medicine
To prevent hyperpigmentation, Animonium crudum, Nitric acid, Secale and Spigelia are recommended. Belladonna, Calcarea carbonica, Iodine and Phosphorus are also helpful. Argentum Nitricum is found to be the best remedy.

 

References
1. Chaker AJ, Vaidya B. Addison disease in adults: diagnosis and management. Am J Med. 2010;123:409-413.

2. Guber HA, Farag AF. Evaluation of endocrine function. In: McPherson RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 24.

3. Ross, I L, Lewitt, N S. Addison’s Disease Symptoms – A Cross Sectional Study in Urban South Africa. Plos One. DOI: 10.1371/journal.pone.0053526

4. Stewart PM, Krone NP. The adrenal cortex. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds.Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Elsevier Saunders; 2011: chap 15.

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