Addison's Disease
Addison's Disease Causes
Causes of adrenal insufficiency can be grouped by the way in which they cause the adrenals to give out insufficient cortisol. These are adrenal dysgenesis (the gland has not formed adequately during development), adrenal destruction (disease processes leading to the gland being damaged), or impaired steroidogenesis (the gland is present but is biochemically unable to produce cortisol).
Addison's Disease Definition
Addison's disease (also known as chronic adrenal insufficiency, hypocortisolism or hypocorticism) is a rare endocrine disorder in which the adrenal gland produces inadequet amounts of steroid hormones (glucocorticoids and often mineralocorticoids). It may arise in children as well as adults, and may occur as the result of a large number of underlying causes. The condition is named after Dr Thomas Addison, the British physician who initially described the condition in his 1855 On the Constitutional and Local Effects of Disease of the Suprarenal Capsules. The adjective "Addisonian" is used for features of the condition, as well as individuals with Addison's disease. The condition is typically diagnosed with blood tests, medical imaging and additional investigations. Treatment is with replacement of the certain hormones (oral hydrocortisone and fludrocortisone). If the disease is the result of an underlying problem, this is addressed. Regular follow-up and monitoring for other health problems is required.
Addison's Disease Symptoms and Signs
The symptoms of Addison's disease arise insidiously, and it may take some time to be recognized. The most common symptoms are muscle weakness, fatigue, weight loss, vomiting, , headache, diarrhea, sweating, changes in mood and personality and joint and muscle pains. Some have characteristic cravings for salt or salty foods due to the urinary losses of sodium. Other symptoms include low blood pressure that falls further when standing (orthostatic hypotension), darkening (hyperpigmentation) of the skin, including areas that are not exposed to the sun; characteristic sites are skin creases (e.g. of the hands), nipples, and the inside of the cheek (buccal mucosa), also old scars may darken, and goiter and vitiligo, signs of the condition that often occur together with Addison's.
Addison's Disease Treatment
Treatment for Addison's disease involves replacing the missing cortisol (usually in the form of hydrocortisone tablets) in a dosing regimen that imitates the physiological concentrations of cortisol. Treatment must typically be continued for life. In addition, many patients need fludrocortisone as replacement for the missing aldosterone. Caution must be exercised when the person with Addison's disease becomes sick, has surgery or becomes pregnant. Medication may be require to be increased during times of stress, infection, or injury.