Addison’s Disease

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Addison’s Disease

What is Addison’s Disease?

Addison’s is a rare disease where the adrenal glands don’t produce enough of the hormones cortisol or aldosterone. The adrenal glands are located above the kidneys. This insufficiency can be caused by the glands not functioning properly or by damage to the adrenal glands. When you are in a stressful situation, your adrenal glands produce cortisol. Aldosterone works to control and regulate sodium and potassium. The adrenal gland also produces androgens or sex hormones.

Is Addison’s Disease inherited?

Scientists don’t know if it can be inherited, or caused by the genes you inherit. However, if you have a family member with Addison’s Disease you have a higher risk of developing it. 

Can Addison’s Disease be cured, or is it fatal?

While Addison’s disease cannot be cured, with prompt diagnosis and treatment the patient can have a normal life span and lead an active life. The symptoms can be treated with medication and changes in your lifestyle. Addison’s Disease patients often have periods of fatigue, or may have other associated health conditions. Today, the prognosis for Addison’s Disease is relatively positive.

What’s the difference between Addison’s and Cushing’s Syndrome?

The chief difference between Addison’s Disease and Cushing’s Syndrome patients is their levels of the hormone cortisol. Addison’s Disease is a lack of sufficient cortisol, and Cushing’s Syndrome occurs when there’s too much cortisol.

Causes

What are the causes of Addison’s Disease?

The main cause of Addison’s Disease is damage to the adrenal glands. The disease is classified as either primary and secondary.

  • Primary adrenal insufficiency occurs when the adrenal glands are damaged and can no longer produce hormones. Damage is often the result of an autoimmune disease. Other causes include:
    • Glucocorticoids used for a prolonged period of time
    • Body infections
    • Cancer or other abnormal growths
    • Some blood thinners used to control blood clotting
  • Secondary adrenal insufficiency occurs when the brain’s pituitary gland can no longer produce adrenocorticotropic hormone (ACTH). ACTH is the hormone that controls the release of hormones from the adrenal gland. Other causes include:
    • Cancer or other abnormal growths
    • Some medications
    • Genetics
    • Traumatic brain injury

What are Addison’s Disease risk factors?

Your risk can increase if you:

  • Take blood thinners
  • Have had surgery to remove any part of the adrenal gland
  • Have an autoimmune disease, like type 1 diabetes or Graves’ disease
  • Have chronic infections such as tuberculosis
  • Have cancer
  • Have a close family member with Addison’s Disease

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Symptoms

What are the symptoms of Addison’s Disease?

Symptoms of Addison’s Disease most often develop between the ages of 30 and 50. Symptoms are similar to other autoimmune diseases and can include:

  • Severe muscle weakness
  • Muscle or joint pain
  • Darkened skin color (hyperpigmentation)
  • Unintentional weight loss or decreased appetite
  • Intestinal issues like nausea, diarrhea, or vomiting
  • Increased salt cravings
  • Fainting
  • Low blood pressure
  • Low blood sugar
  • Irritability or depression
  • Sleep disturbances
  • Loss of underarm or pubic hair in women

What is acute adrenal failure?

Called Addisonian crisis, acute adrenal failure is the sudden symptoms that occur when untreated Addison’s Disease causes an extremely low level of cortisol. The symptoms of shock that occur with Addisonian crisis can be life-threatening. The patient must get medical attention immediately. 

Addisonian crisis can cause any of the following symptoms:

  • Low blood pressure
  • High potassium levels (hyperkalemia)
  • Low sodium levels (hyponatremia)
  • Pain in the lower half of the body or legs
  • Reduced consciousness, delirium, or confusion
  • Severe weakness
  • Severe abdominal pain, vomiting, diarrhea, or dehydration

Diagnosis

How is Addison’s Disease diagnosed?

After your doctor asks about your medical history and your symptoms, you may have some of the following tests:

  • Blood test to measure the amount of potassium, sodium, cortisol, and ACTH in your bloodstream. It can also measure the antibodies that your body would produce if you had Addison’s Disease caused by an autoimmune disorder.
  • ACTH stimulation test measures the level of cortisol in your blood after an injection of synthetic ACTH. In a healthy body, ACTH would signal the adrenal glands to produce cortisol.
  • Insulin-induced hypoglycemia test is used to differentiate between primary and secondary adrenal insufficiency. It checks your blood glucose and cortisol levels after an injection of insulin. A healthy response after an insulin injection is a decrease in your glucose levels and an increase in cortisol levels.

Treatment

How is Addison’s Disease treated?

Since Addison’s Disease cannot be cured, treatment focuses on symptom management. Your treatment plan will likely include:

  • Taking your prescribed medications consistently and likely for life. Medications can include hormone replacements to compensate for the lack of production by your adrenal glands. They may also include glucocorticoid medications that will reduce inflammation and improve quality of life.
  • Home and self-care may also be required. This includes always having access to an emergency supply of all necessary medications, a medical alert card in your wallet or bracelet on your wrist, and an injectable corticosteroid for emergencies.
  • Increased stress can have a negative impact on Addison’s Disease treatment. Alternative therapies that reduce stress levels - like yoga or meditation - may be recommended.

References

Macon, B. L. (2019, July 19). Addison’s Disease. Healthline. https://www.healthline.com/health/addisons-disease#diagnosis
Mayo Foundation for Medical Education and Research. (2020, November 24). Addison’s Disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/addisons-disease/symptoms-causes/syc-20350293 
Mayo Foundation for Medical Education and Research. (2021, April 30). Cushing Syndrome. Mayo Clinic.https://www.mayoclinic.org/diseases-conditions/cushing-syndrome/symptoms-causes/syc-20351310
U.S. Department of Health and Human Services. (n.d.). Addison’s disease. Genetic and Rare Diseases Information Center. https://rarediseases.info.nih.gov/diseases/5740/addisons-disease
U.S. National Library of Medicine. (2020, August 18). Autoimmune Addison Disease. MedlinePlus. https://medlineplus.gov/genetics/condition/autoimmune-addison-disease/#inheritance

Information

Medically reviewed by:

Stuart Seigel, MD

Dr. Seigel is a board certified Endocrinologist. He completed his residency in internal medicine and fellowship in endocrinology, diabetes and metabolism at the University Of Pittsburgh Medical Center in 2011 and 2013.

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