Addison's Disease
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Addison's Disease

(Adrenal Insufficiency; Adrenocortical Hypofunction; Chronic Adrenocortical Insufficiency; Hypoadrenalism)

En Español (Spanish Version)

Definition

Addison's disease is a rare disorder of the adrenal glands. In the case of Addision's, the glands do not produce enough of the hormones cortisol and aldosterone.

Adrenal Glands

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Addison's occurs because of damage to the cortex.

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Causes

Addison's disease is the result of gradual damage to the adrenal cortex, the outer layer of the adrenal gland. This damage may be caused by:

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

Symptoms

Symptoms may include:

  • Extreme weakness, fatigue
  • Weight loss
  • Nausea or vomiting
  • Chronic diarrhea
  • Muscle weakness
  • Darkening of freckles, nipples, scars, skin creases, gums, mouth, nail beds, and vaginal lining
  • Emotional changes, especially depression
  • Craving for salty foods
  • Abdominal pain
  • Anorexia
  • Amenorrhea

A severe complication of Addison's disease is the Addisonian or adrenal crisis . Adrenal crisis is a life threatening disorder, its symptoms include:

  • Severe abdominal, back, or leg pain
  • Fainting
  • Severe low blood pressure
  • Severe dehydration
  • Severe nausea, vomiting, and diarrhea
  • Low blood sugar
  • Generalized muscle weakness

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include:

  • Blood and urine tests—to see if you have low levels of cortisol and aldosterone, high level of ACTH (ACTH is a hormone that stimulates the adrenal glands), and to measure levels of:
    • Sodium
    • Chloride
    • Calcium
    • Potassium
    • Bicarbonate
    • Blood urea nitrogen levels
    • Anti-adrenal antibody (rarely done)
  • ACTH stimulation test —measures cortisol in the blood before and after an injection of ACTH
  • X-rays —pictures of the abdomen to see if the adrenal glands have signs of calcium deposits
  • CT scan of the abdomen—a type of x-ray that uses a computer to make pictures of structures inside the body, in this case the adrenal glands

Treatment

Symptoms of Addison's disease can be controlled with medications. These drugs replace the missing hormones. Medication needs to be taken for the rest of your life. They may be increased in times of stress.

Medications may include:

  • Cortisone acetate
  • Hydrocortisone tablets
  • Fludrocortisone acetate (Florinef)

Immediate treatment of adrenal crisis includes:

  • Hydrocortisone by IV (into vein)
  • Normal saline (salt water) by IV

Maintenance

Regular blood tests are needed to monitor your response to medication. Wear a medical alert bracelet that states adrenal insufficiency or Addison's disease in case of an emergency.

Prevention

There are no guidelines for preventing Addison's disease. If you think you are at risk, talk to your doctor.

RESOURCES:

Addison's Disease.net
http://www.addisonsdisease.net/

The Adrenoleukodystrophy Foundation
http://www.aldfoundation.org/

National Adrenal Diseases Foundation
http://www.nadf.us/

CANADIAN RESOURCES:

The Canadian Addison Society
http://www.addisonsociety.ca/

Health Canada
http://www.hc-sc.gc.ca/index-eng.php/

References:

Addison's disease. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health/endo/pubs/addison/addison.htm . Accessed November 9, 2009.

Arlt W, Allolio B. Adrenal insufficiency. Lancet . 2003;361(9372):1881-1893.

Dorin RI, Qualls CR, Crapo LM. Diagnosis of adrenal insufficiency. Ann Int Med . 2003;138:3:194-214.

Hahner S, Allolio B. Therapeutic management of adrenal insufficiency. Best Pract Res Clin Endocrinol Metab . 2009;23(2):167-79.

Salvatori R. Adrenal insufficiency. JAMA . 2005;294:2481-2488.

Ten S, New M, Maclaren N. Clinical Review 130: Addison's disease. J Clin Endo Metabol . 2001;86:2909-2922.

Thomas Z, Fraser GL. An update on the diagnosis of adrenal insufficiency and the use of corticotherapy in critical illness. Ann Pharmather . 2007;41:1456-65.

Wallace I, Cunningham S, Lindsay J. The diagnosis and investigation of adrenal insufficiency in adults. Ann Clin Biochem . 2009;46(Pt 5):351-367.



Last reviewed September 2010 by B. Gabriel Smolarz, MD


Last updated Updated: 5/11/2011

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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