Addison's Disease

(Adrenal Insufficiency; Adrenocortical Hypofunction; Chronic Adrenocortical Insufficiency)

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Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention | Organizations

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Definition

Addison's disease is a rare disorder of the adrenal glands, in which they do not produce enough of the hormones cortisol and aldosterone. The adrenal glands are two small glands that sit on top of each kidney.

Causes

Addison's disease is the result of gradual damage to the adrenal cortex, the outer layer of the adrenal gland. This damage may be caused by:

• The body's immune system attacking the gland (autoimmune disease)
• Tuberculosis
• Chronic infections
• Cytomegalovirus (CMV) associated with AIDS
• Fungal infections, including:
  • Blastomycosis
  • Histoplasmosis
  • Coccidioidomycosis
• Cancer including metastases from:
  • Breast, lung, kidney, or colon cancer
  • Lymphoma
  • Kaposi's sarcoma
• Regular corticosteroid treatment
• Bleeding within the adrenal glands (related to use of anticoagulant medications and shock)
• Medications (such as ketoconazole or etomidate)
• Radiation treatment
• Chronic illness, including:
  • Sarcoidosis
  • Hemachromatosis
  • Amyloidosis
  • Adrenoleukodystrophy
  • Adrenomyelodystrophy

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

• Type I diabetes
• Pernicious anemia
• Hypoparathyroidism
• Hypopituitarism
• Grave's Disease
• Myasthenia gravis
• Stress
• Anticoagulant medications
• Abdominal injury
• Family members with autoimmune-caused Addison's disease
• Long-term steroid medication treatment, followed by:
  • Severe stress
  • Infection
  • Surgery
  • Trauma
• Previous surgery on adrenal glands

Symptoms

Symptoms may include:

• Extreme weakness, fatigue
• Dizziness
• Loss of appetite
• Weight loss
• Nausea or vomiting
• Chronic diarrhea
• Muscle weakness
• Skin rash or lesions on the feet or hands
• Intolerance to cold
• Darkening of freckles, nipples, scars, skin creases, gums, mouth and vaginal lining
• Emotional changes, especially depression
• Craving for salty foods
• Hair loss in women

A severe complication of Addison's disease is Addison's crisis or adrenal crisis. Symptoms include:

• Severe low blood pressure
• Dehydration
• Nausea and vomiting
• Low blood sugar

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:

• Blood and urine tests – to see if you have low levels of cortisol and aldosterone, and to measure levels of:
  • Sodium
  • Potassium
  • Bicarbonate
  • Blood urea nitrogen levels

• ACTH stimulation test – measures cortisol in the blood and/or urine before and after an injection of ACTH (ACTH is a hormone that stimulates the adrenal glands.)

• Insulin-induced hypoglycemia test – measures glucose and cortisol levels in the blood before and after an injection of insulin

• X-rays – pictures of the abdomen to see if the adrenal glands have signs of calcium deposits

• CT scan – a series of x-ray pictures of the pituitary and adrenal glands

Treatment

Symptoms of Addison's disease can be controlled with medications called corticosteroids. Medication needs to be taken for the rest of your life, and may be increased in times of stress.

Medications may include:

• Cortisone acetate
• Hydrocortisone tablets
• Fludrocortisone acetate (Florinef)

Immediate treatment of adrenal crisis includes:

• Hydrocortisone
• Salt water
• Sugar

Maintenance: See your doctor regularly for blood tests to monitor your response to medication. Wear a medical alert bracelet in case of emergency.

Prevention

There are no guidelines for preventing Addison's disease. If you think you are at risk for Addison's disease, talk to your doctor about ways to reduce your risk factors.

Organizations

National Adrenal Diseases Foundation
http://www.medhelp.org/nadf/

SOURCE:

National Institute of Diabetes and Digestive and Kidney Diseases

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Last reviewed June 2001 by Medical Review Board