Addison’s Disease

Addison’s disease is a rare disease caused by destruction of the outer layer of the adrenal glands, which are situated on the two kidneys. This can be caused by Tuberculosis (TB) or an autoimmune destruction. Because it is a rare disease and often exists in a mild form and mimics other diseases, it is difficult to diagnose. For instance, loss of appetite, fatigue etc are found in many other illnesses also. Diagnosis usually depends upon blood tests and patients do not usually have batteries of blood tests and intravenous tests. A further confusing factor is that the disease is often found along with other diseases such as diabetes and hypothyroidism and tuberculosis. If pigmentation of the skin (brownish patches or sun-tanned appearance or even blemish spots), the diagnosis is made easier. This may occur only at a late stage. Tests depend on the ability of the adrenal glands to respond to ACTH (a hormone which can be used as a medicine but comes from the pituitary gland in the brain and directs the adrenal cortex to “start working”).

Patients often have a small pulse, lack of vigour and have biochemical disturbances in the blood (too little sodium and too much potassium), they lack lose weight and salt (sodium chloride). They also have low blood pressure and may have diarrhoea or constipation and females may have period problems. The two important hormones produced by the adrenal glands are cortisol and aldosterone, they are produced in different amounts at different times by a healthy person.

These patients respond badly to stress and injuries and operations. Operations, accidents, fasting, injections etc may cause and “Addisionian crisis”, in which the patient goes into shock, collapses and may die if untreated.

Usually in a crisis intravenous fluid is given and other treatment in hospital. Fortunately much research has been done on the disease and patients are able to lead normal lives nowadays.

Treatment is aimed at simulating the normal rates of secretion of cortisol (hydrocortis and aldosterone). Fludrocortisone which is a synthetic substitute for aldosterone has been developed in laboratories and works well. They are also given hydrocortisone. Patients have to take the above (in oral form) in much the same way as many diabetics need insulin daily. Extra care is needed during stress such as after an accident. They may need salt solutions to drink and extra medication at such times.

Cortisol

• belongs to a family of hormones called glucocorticoids
• helps maintain blood pressure and cardiovascular function
• helps mobilize nutrients and modify the body’s response to inflammation
• helps balance the effects of insulin in breaking down sugar for energy
• helps regulate the metabolism of proteins, carbohydrates and fats
• helps the body to respond to stress

Aldosterone

• belongs to a family of hormones called mineralocorticoids
• helps to maintain proper sodium (salt) and potassium balance

Some of the symptoms of Addison’s Disease:

• salt craving
• weakness and fatigue
• hyperpigmentation of skin and mucous membranes
• weight loss
• nausea, vomiting
• constipation or diarrhea
• low blood pressure
• abdominal pain
• lethargy
• confusion
• fainting, particularly on standing up
• muscle complaints

However, patients with Addison’s disease are advised to follow the treatment of their own GPs and Specialists, as individual cases do vary. Infections, fever etc may need special prompt treatment.