Addison's Disease
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
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:
- The body's immune system attacking the gland (autoimmune disease), which accounts for 85% of cases in developed countries
- Tuberculosis (major cause in the Third World countries)
- Bleeding within the adrenal glands (related to use of anticoagulant medications and shock (low blood pressure))
- Surgical complication
- Congenital (present at birth) or genetic factors (enzyme defects, familial glucocorticoid insufficiency)
- Cytomegalovirus (CMV) associated with AIDS
-
Fungal infections, including:
- Blastomycosis
- Histoplasmosis
- Coccidioidomycosis
- Cancer including metastases from:
- Medications (such as ketoconazole or etomidate)
- Radiation treatment
-
Chronic illness, including:
- Sarcoidosis
- Hemachromatosis
- Amyloidosis
- Adrenoleukodystrophy
- Adrenomyelodystrophy
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
- Having the following autoimmune diseases can put you at risk for an associated autoimmune-based Addison’s disease:
- Stress
- Anticoagulant medications
- Abdominal injury
- Family members with autoimmune-caused Addison's disease
-
Long-term steroid medication treatment, followed by:
- Severe stress
- Infection
- Surgery
- Trauma
- Previous surgery on adrenal glands
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:
American Academy of Family Physicians
The Endocrine Society
National Institute of Diabetes and Digestive and Kidney Diseases
Canadian Resources:
Canadian Addison Society
Health Canada
References:
Addison's disease. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health/endo/pubs/...ison/addison.htm. Accessed Nov 9th 2009.
Arlt W, Allolio B. Adrenal insufficiency. Lancet. 2003 May 31;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 Apr;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 Sep;46(Pt 5):351-67.
Last reviewed November 2009 by Bridget Sinnott, MD, FACE
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.