Addison's disease or Hypocortisolism or Hypoadrenalism is a medical condition where adrenal glands produce insufficient cortisol and also aldosterone as well. This condition is also known as adrenal insufficiency and it can affect both the sexes and all the age groups. Addison's disease or Hypocortisolism or Hypoadrenalism is a serious and life-threatening disease. For Addison's disease the treatment comprises of replacing the insufficient cortisol by taking hormones so as to balance the harmful effects and to produce the beneficial effects, as generated from the natural hormones.
Primary Adrenal Insufficiency
As mentioned above, Addison's disease or Hypocortisolism or Hypoadrenalism occurs as a result of damage to the cortex of the adrenal gland and not being able to produce hormones in sufficient quantities. When this condition occurs due to damage to adrenal glands, then this is known as primary adrenal insufficiency. The commonest cause for adrenal glands not being able to make adrenocortical hormones is problem with our immune system, where the body mistakenly attacks itself; like in autoimmune disease where our immune system misinterprets the adrenal cortex as a foreign entity and starts attacking it resulting in decreased production of hormones from adrenal glands.
Other Causes Of Addison's Disease or Hypocortisolism or Hypoadrenalism Include:
- When the cancer metastasizes to adrenal glands
- Other adrenal glands' infection.
- Hemorrhaging into adrenal glands
Secondary Adrenal Insufficiency
Adrenal insufficiency could also happen if the pituitary gland is affected by some medical disorder, then it results in decreased production of ACTH or adrenocorticotropic hormone. The function of ACTH is stimulating the adrenal cortex to generate its own hormones. Decreased production of ACTH leads to decreased production of hormones from adrenal glands. So the condition where our adrenal glands are fine and are not damaged, but are unable to produce sufficient hormones due to decreased ACTH is known as Secondary Adrenal Insufficiency.
When individuals take corticosteroids as a treatment for other medical conditions and stop them abruptly, then this may also result in development of secondary adrenal insufficiency.
Causes of Addison's Disease or Hypocortisolism or Hypoadrenalism
The cause of Addison's disease or Hypocortisolism or Hypoadrenalism is damaging of adrenal glands resulting in production of decreased level hormones, such as cortisol and aldosterone. The commonest cause of Addison's disease is immune system problems. Some of the important hormones produced by adrenal glands are glucocorticoids and the mineralocorticoids.
- Glucocorticoids: Cortisol comes under this hormone and the function of cortisol is to help in conversion of food into energy. It also helps with the immune system's inflammatory response, i.e. helps your body respond to stress.
- Mineralocorticoids: Aldosterone comes under this group of hormones and the function of this hormone is managing the body's sodium and potassium levels and helping in keeping the blood pressure normal.
- Androgens: These are the sex hormones present in men and are produced by adrenal glands in males, as well as females. Their function is sexual development in males.
Signs and Symptoms of Addison's Disease or Hypocortisolism or Hypoadrenalism
- Fatigue and weakness of the muscles.
- Reduced appetite and weight loss.
- Hypotension (decreased blood pressure).
- Cravings for salty things.
- Hypoglycemia (decreased blood sugar).
- Vomiting or diarrhea.
- Joint pain.
- Muscle pain.
- Depression and irritability.
- Loss of body hair.
- Women may experience sexual dysfunction.
Addisonian Crisis Due to Addison's Disease or Hypocortisolism or Hypoadrenalism
This is a life-threatening condition which occurs as a result of untreated Addison's Disease or Hypocortisolism or Hypoadrenalism and is triggered by injury, illness or infection. This serious condition results in hypotension or low blood pressure, hypoglycemia (low blood sugar levels), hyperkalemia (high blood potassium levels). This is a grave condition and requires immediate medical attention. Treatment comprises of I.V. injections of hydrocortisone, saline solution and sugar (dextrose).
Symptoms of Addisonian Crisis (Acute Adrenal Failure)
This is a condition where there is abrupt onset of signs and symptoms of Addison's disease which include:
- Low back pain.
- Pain in the abdomen or legs.
- Severe diarrhea and vomiting resulting in dehydration.
- Hypotension (low BP).
- Hyperkalemia (high potassium).
Serious Symptoms Requiring Immediate Medical Condition Are:
- Hyperpigmentation of the skin.
- Extreme tiredness.
- Unintentional weight loss.
- Problems with the gastrointestinal system, such as abdominal pain, nausea and vomiting.
- Salt cravings.
- Joint pain or muscle pain.
Investigations for Addison's Disease or Hypocortisolism or Hypoadrenalism
- Medical history and physical exam.
- Blood tests to measure the cortisol level, potassium, sodium and ACTH in the blood. A blood test also helps in assessing the antibodies related to autoimmune Addison's disease.
- ACTH stimulation test measures the cortisol level in the blood.
- Insulin-induced hypoglycemia test is done to find out if the pituitary disease is the cause for adrenal insufficiency (secondary adrenal insufficiency).
- Imaging tests such as abdominal CT scan and MRI scan helps in assessing adrenal glands for any abnormalities and also helps in assessment of their size.
Treatment Modalities for Addison's Disease or Hypocortisolism or Hypoadrenalism
Treatment consists of hormone replacement therapy to balance the levels of hormones which are being produced in insufficient quantities. Treatment options include:
- Oral Corticosteroids, such as fludrocortisone, is used for replacing aldosterone. Hydrocortisone (Cortef), prednisone can be used as a replacement of cortisol.
- Corticosteroid Injections are given if the patient is vomiting and cannot keep down oral medications.
- Androgen Replacement Therapy using dehydroepiandrosterone is done for treating androgen deficiency in women.
Other than these treatment choices, patient is recommended to use liberal amount of sodium, particularly if the patient is participating in heavy activity or exercises, during summer time, or if there is any problem with the gastrointestinal system. The physician may also temporarily increase the dosage if the patient is undergoing anything stressful, such as a surgery, illness, infection etc.