Addison's Disease Causes, Symptoms, Diagnosis, Treatment, Prevention

Addison's Disease Causes, Symptoms, Diagnosis, Treatment, Prevention

What is Addison's disease?

Addison’s disease is a disorder in which the adrenal glands--which sit on top of the kidneys--do not produce enough of the hormones cortisol and aldosterone. (Hormones are chemicals that control the function of tissues or organs.)

Addison's Disease Causes, Symptoms, Diagnosis, Treatment, Prevention
Addison's disease occurs in all age groups and affects both sexes. Addison's disease can be life-threatening.

Cortisol helps the body respond to stress, including the stress of illness, injury, or surgery. It also helps maintain blood pressure, heart function, the immune system, and blood glucose (sugar) levels.

Aldosterone affects the balance of sodium and potassium in the blood, which in turn controls the amount of fluid the kidneys remove as urine, which affects blood volume and blood pressure.

Addison’s disease  is also called “primary adrenal insufficiency.” A related disorder, “secondary adrenal insufficiency,” occurs when the pituitary, a small gland at the base of the brain, does not secrete enough adrenocorticotropic hormone (ACTH), which activates the adrenal glands to produce cortisol.

Treatment for Addison's disease involves taking hormones to replace the insufficient amounts being made by your adrenal glands, in order to mimic the beneficial effects produced by your naturally made hormones.

Read more:

Causes, symptoms, diagnosed and treatment for Attention Deficit Hyperactivity Disorder (ADHD)

What causes and rick factors of Addison’s disease?

Causes of Addison’s disease

Addison’s disease is caused by an autoimmune response, which occurs when the body’s immune system (which protects it from infection) assaults its own organs and tissues. With Addison’s disease, the immune system attacks the outer portion of the adrenal glands (the cortex), where cortisol and aldosterone are made.

Other causes of Addison’s disease include:

  • injury to the adrenal glands
  • infection, including tuberculosis, HIV/AIDS-related infections, and fungal infections
  • cancer cells from another part of the body that have invaded the adrenal glands
  • bleeding into the adrenal glands
  • surgical removal of the adrenal glands
  • amyloidosis (abnormal buildup of certain proteins in the organs)
  • genetic defects

Risk factors for the autoimmune type of Addison's disease include other autoimmune diseases:

Addison's Disease Causes, Symptoms, Diagnosis, Treatment, Prevention
Addison's Disease

  • Chronic thyroiditis
  • Dermatis herpetiformis
  • Graves' disease
  • Hypoparathyroidism
  • Hypopituitarism
  • Myasthenia gravis
  • Pernicious anemia
  • Testicular dysfunction
  • Type I diabetes
  • Vitiligo

What are the symptoms of Addison’s disease?

Common symptoms of Addison's Disease

The damage to the adrenal glands happens slowly over time, and symptoms occur gradually. The most common symptoms include:

  • abdominal pain
  • abnormal menstrual periods
  • craving for salty food
  • dehydration
  • depression
  • diarrhea
  • irritability
  • lightheadedness or dizziness when standing up
  • loss of appetite
  • low blood glucose
  • low blood pressure
  • muscle weakness
  • nausea
  • patches of dark skin, especially around scars, skin folds, and joints
  • sensitivity to cold
  • unexplained weight loss
  • vomiting
  • worsening fatigue (extreme tiredness)

Symptoms of an Addisonian crisis 

In some cases – such as an injury, illness, or time of intense stress – symptoms can come on quickly and cause a serious event called an Addisonian crisis, or acute adrenal insufficiency. An Addisonian crisis is a medical emergency. If it is not treated, it can lead to shock and death. Symptoms of an Addisonian crisis include:

  • feeling restless, confused, or afraid, or other mental changes
  • dehydration
  • extreme weakness
  • having trouble staying awake, or a total loss of consciousness
  • high fever
  • lightheadedness or feeling faint
  • paleness
  • severe vomiting and diarrhea
  • sudden, deep pain in the lower back, belly, or legs

When to see a doctor

See your doctor if you have signs and symptoms that commonly occur in people with Addison's disease, such as:

  • Darkening areas of skin (hyperpigmentation)
  • Severe fatigue
  • Unintentional weight loss
  • Gastrointestinal problems, such as nausea, vomiting and abdominal pain
  • Dizziness or fainting
  • Salt cravings
  • Muscle or joint pains
Your doctor can help determine whether Addison's disease or some other medical condition may be causing these problems.

Diagnosis of Addison's disease

Diagnosis may involve:
  • History and physical – Your doctor will review your symptoms and perform a physical exam. Dark patches on your skin might be a clue for your doctor to consider testing for Addison’s disease.
  • Biochemical tests, which measure cortisol levels before and after a challenge injection of synthetic ACTH, known as a 'short synacthen test'. Synacthen tests will indicate the person's baseline level of cortisol production and their response to an increased need for cortisol in the body. An person who suffers from Addison’s may show a flat or reduced response
  • Blood electrolyte and plasma renin tests, which will indicate if there is a need for mineralocorticoid replacement
  • Anti-adrenal antibody test – if the result is positive, primary Addison's disease is definitively diagnosed. However, even if these antibodies do not exist, the person may still have Addison's disease
  • X-rays, ultrasounds and CAT scans of the abdominal region to check for visual signs of damage and the size of adrenal glands.
  • Computed tomography (CT scan) – Computed tomography uses computers to combine many X-ray images into cross-sectional views. A CT scan might be done to evaluate the adrenals and/or pituitary gland. For example, it can show if the immune system has damaged the adrenal glands or if the glands are infected.

Treatments and drugs for Addison's Disease

All treatment for Addison's disease involves hormone replacement therapy to correct the levels of steroid hormones your body isn't producing. Some options for treatment include:

  • Oral corticosteroids. Your doctor may prescribe fludrocortisone to replace aldosterone. Hydrocortisone (Cortef), prednisone or cortisone acetate may be used to replace cortisol.
  • Corticosteroid injections. If you're ill with vomiting and can't retain oral medications, injections may be needed.
  • Androgen replacement therapy. To treat androgen deficiency in women, dehydroepiandrosterone can be prescribed. Some studies suggest that this therapy may improve overall sense of well-being, libido and sexual satisfaction.

An ample amount of sodium is recommended, especially during heavy exercise, when the weather is hot, or if you have gastrointestinal upsets, such as diarrhea. Your doctor will also suggest a temporary increase in your dosage if you're facing a stressful situation, such as an operation, an infection or a minor illness.

Addisonian crisis 

An addisonian crisis is a life-threatening situation that results in low blood pressure, low blood levels of sugar and high blood levels of potassium. This situation requires immediate medical care. Treatment typically includes intravenous injections of:

  • Hydrocortisone
  • Saline solution
  • Sugar (dextrose)

How to Prevent Addison's Disease

Addison's disease itself can't be prevented. However, it's possible to prevent Addisonian crises, or medical emergencies caused by untreated Addison's disease.

The following risk factors may prevent Addison’s disease include:
  • Treating fungal infections.
  • Controlling diabetes.
  • Identify cancer symptoms to prevent spread of cells into adrenal glands and bloodstream. 
  • Treating bacterial infection such as tuberculosis

By taking prescribed medications every day and increasing dosage during times of stress or illness, Addison's disease can be kept under control. If you think you are at risk, talk to your doctor.

What is the outlook for people with Addison’s disease?

People who have Addison’s disease will need to take medicine for the rest of their lives and can live normal healthy lives.

If you have Addison’s disease, you should carry an identification card and wear a bracelet at all times to let medical personnel know you have the disease.

Always have extra medicine on hand in case you become ill and need more. Ask your doctor about keeping a shot of cortisol for emergencies, and be sure someone with you knows how to give you the shot.