Addisons Disease is a disorder that results when the adrenal glands produce an insufficient amount of cortisol and often aldosterone. Cortisol is a hormone that helps slow inflammation response of the immune system, helps maintain heart function and blood pressure, and balances insulin’s roll in breaking sugar down into energy. A lack of production is also known as an adrenal insufficiency or hypocortisolism. It can occur at any age, but more commonly affects those ages 30 to 50 years. This condition can be life threatening.
Symptoms of this disorder develop slowly and can take up to several months to appear. Most common symptoms include low blood pressure or fainting, nausea, vomiting, diarrhea, muscle weakness, and fatigue. Some symptoms of the disease can appear suddenly and could be signs of acute adrenal failure known as Addisonian Crisis. These symptoms can include pain in the lower back, abdomen or legs, severe vomitting or diarrhea that lead to dehydration, loss of consciousness or hyperkalemia.
The two adrenal glands are located directly above each of the kidneys and are composed of two sections. The interior or medulla produces hormones that are adrenaline like and the outer layer or cortex produces corticosteroids. The hormones produced by the cortex are essential. Both glucocorticoids and mineralocorticoids are necessary for life. Glucocorticoids influence the body’s ability to turn food into energy and play a part in the immune system’s inflammatory response to react to stress. Mineralocorticoids maintain the body’s level of potassium to sodium to water and keep blood pressure regulated. Addison’s disease occurs after damage to the cortex. When the adrenal glands fail and adrenocortical hormones are not produced, the immune system weakens and views the adrenal cortex as a foreign body. It then attacks and attempts to destroy it. It can also occur if the adrenal gland is nonfunctioning. Injury, infection, or illness can all result in this disease.
Diagnosis can be difficult but achievable after laboratory tests confirm the level of cortisol in the body. X-rays of the pituitary and adrenal glands are taken to look for possible causes. An ACTH (adrenocorticotropic hormone) stimulation test is the only specific test for this disease. Cortisol levels are examined from both blood and urine before and after an injection of this hormone is given. If there is no response to the injections, an adrenal insufficiency is diagnosed. Other tests like a tuberculosis skin test can indicate calcium deposits which are signs of adrenal issues.
Treatments for Addisons Disease may involve corticosteroid prescriptions to replace the ones that are not being produced by the body. Cortef replaces cortisol, while Florinef replaces the aldosterone that is under produced. Taking these medications orally only mimics the normal amount the body produces. Injections are necessary with surgeries or illness that can cause vomiting and reduce the amount that is received. With Addisonian crisis, IV injections or hydrocortisone, saline and dextrose are used to replenish the system and stabilize blood pressure. Both types of Addisons Disease are treated solely with medication.