Hormonal/Endocrine
Addison's Disease
Common Symptoms
- Extreme fatigue
- Weight loss and decreased appetite
- Darkening of your skin (hyperpigmentation)
- Low blood pressure, which may cause dizziness or fainting
- Salt craving
- Muscle or joint pains
- Nausea, diarrhea or vomiting
- Irritability and depression
Diagnosis
Diagnosis typically begins with a review of symptoms and a physical exam. It is confirmed through blood tests that measure levels of sodium, potassium, cortisol, and ACTH. An ACTH stimulation test, which measures the adrenal glands' response after an injection of synthetic ACTH, is a key diagnostic tool. Imaging tests like CT scans may be used to check the size of the adrenal glands or look for other potential causes.
Causes
The most common cause of Addison's disease is an autoimmune response, where the body's immune system mistakenly attacks and destroys the adrenal cortex—the outer layer of the adrenal glands. This damage prevents the glands from producing adequate levels of the hormones cortisol and aldosterone. Less common causes include infections such as tuberculosis, cancer that has spread to the adrenal glands, and bleeding into the adrenal glands. A related condition, secondary adrenal insufficiency, occurs when the pituitary gland fails to produce enough adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce cortisol.
Treatment Overview
Treatment involves hormone replacement therapy to correct the levels of hormones the adrenal glands are not producing. This typically includes oral corticosteroids to replace cortisol and sometimes a medication called fludrocortisone to replace aldosterone. Treatment is lifelong, and medication dosages may need to be adjusted during periods of stress, illness, or surgery.
Prognosis & Outlook
With consistent and appropriate hormone replacement therapy, individuals with Addison's disease can live a normal, active life with a normal life expectancy. The key to a good prognosis is strict adherence to medication schedules and knowing when to seek medical advice for dose adjustments to prevent an adrenal crisis.
Types & Variants
Primary Adrenal Insufficiency
This is Addison's disease, caused by direct damage to the adrenal glands, most often from an autoimmune attack.
Secondary Adrenal Insufficiency
This occurs when the pituitary gland doesn't produce enough ACTH hormone, leading to a drop in cortisol production by otherwise healthy adrenal glands.
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