Adrenal Insufficiency & Addison's Disease

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Overview

Addison’s disease is a chronic condition in which your adrenal glands don’t produce enough of the hormones cortisol and aldosterone.

Your adrenal glands, also known as suprarenal glands, are small, triangle-shaped glands that are located on top of each of your two kidneys. They’re a part of your endocrine system.

Cortisol is a hormone that helps your body respond to stress, including the stress of illness, injury or surgery. It also helps maintain your blood pressure, heart function, immune system and blood glucose (sugar) levels. Cortisol is essential for life.

Aldosterone is a hormone that affects the balance of sodium (salt) and potassium in your blood. This in turn controls the amount of fluid your kidneys remove as urine (pee), which affects blood volume and blood pressure.

Addison’s disease is also called primary adrenal insufficiency. A related disorder, secondary adrenal insufficiency, happens when your pituitary gland doesn’t release enough adrenocorticotropic hormone (ACTH), which activates your adrenal glands to produce cortisol.


Symptoms

People who have Addison’s disease may experience the following symptoms:


muscle weakness

fatigue and tiredness

darkening in skin color

weight loss or decreased appetite

a decrease in heart rate or blood pressure

low blood sugar levels

fainting spells

sores in the mouth

cravings for salt

nausea

vomiting

People living with Addison’s disease may also experience neuropsychiatric symptoms, such as:

irritability or depression

lack of energy

sleep disturbances

If Addison’s disease goes untreated for too long, it can become an Addisonian crisis. Symptoms associated with an Addisonian crisis can includeTrusted Source:

agitation

delirium

visual and auditory hallucinations

An Addisonian crisis is a life-threatening medical emergency. Call 911 immediately if you or someone you know begins to experience:

mental status changes, such as confusion, fear, or restlessness

loss of consciousness

high fever

sudden pain in the lower back, belly, or legs

An untreated Addisonian crisis can lead to shock and death

Causes

Addison's disease is caused by damage to your adrenal glands, resulting in not enough of the hormone cortisol and, often, not enough aldosterone as well. Your adrenal glands are part of your endocrine system. They produce hormones that give instructions to virtually every organ and tissue in your body.

Your adrenal glands are composed of two sections. The interior (medulla) produces adrenaline-like hormones. The outer layer (cortex) produces a group of hormones called corticosteroids. Corticosteroids include:

Glucocorticoids. These hormones, which include cortisol, influence your body's ability to convert food into energy, play a role in your immune system's inflammatory response and help your body respond to stress.

Mineralocorticoids. These hormones, which include aldosterone, maintain your body's balance of sodium and potassium to keep your blood pressure normal.

Androgens. These male sex hormones are produced in small amounts by the adrenal glands in both men and women. They cause sexual development in men, and influence muscle mass, sex drive (libido) and a sense of well-being in both men and women.

Risk factors

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

Type I diabetes.

Hypoparathyroidism.

Hypopituitarism.

Pernicious anemia.

Testicular dysfunction.

Graves' disease.

Chronic thyroiditis.

Candidiasis.

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Complications

If you have untreated Addison's disease, you may develop an addisonian crisis as a result of physical stress, such as an injury, infection or illness. Normally, the adrenal glands produce two to three times the usual amount of cortisol in response to physical stress. With adrenal insufficiency, the inability to increase cortisol production with stress can lead to an 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. You will need immediate medical care.

People with Addison's disease commonly have associated autoimmune diseases.


Prevention

Addison's disease can't be prevented, but there are steps you can take to avoid an addisonian crisis:

Talk to your doctor if you always feel tired, weak, or are losing weight. Ask about having an adrenal shortage.

If you have been diagnosed with Addison's disease, ask your doctor about what to do when you're sick. You may need to learn how to increase your dose of corticosteroids.

If you become very sick, especially if you are vomiting and you can't take your medication, go to the emergency room.

Some people with Addison's disease worry about serious side effects from hydrocortisone or prednisone because they know these occur in people who take these steroids for other reasons.

However, if you have Addison's disease, the adverse effects of high-dose glucocorticoids should not occur, since the dose you are prescribed is replacing the amount that is missing. Make sure to follow up with your doctor on a regular basis to make sure your dose is not too high.