Disease, Illness and Condition Library
Addison's Disease
resulting in a deficiency of all adrenal hormones. The body has two adrenal glands, one near the top of each kidney. The inner part (medulla) of the adrenal glands secretes hormones, such as adrenaline (epinephrine), that help control blood pressure, heart rate, sweating, and other activities regulated by the sympathetic nervous system. The outer part (cortex) secretes different hormones, including corticosteroids (cortisone like hormones, such as cortisol) and mineralocorticoids (particularly aldosterone, which controls blood pressure and the levels of salt and potassium in the body). The adrenal glands also play a role in stimulating the production of androgens (testosterone and similar hormones). The adrenal glands are controlled in part by the brain. The hypothalamus, a small gland in the brain involved in hormonal regulation, produces corticotropin releasing hormones and vasopressin. These two hormones trigger the pituitary gland to secrete corticotrophin (also known as adrenocorticotropic hormone or ACTH), which stimulates the adrenal glands to produce corticosteroids. The rennin-angiotensin-aldosterone system, regulated mostly by the kidneys, causes the adrenal glands to produce more or less aldosterone. The body controls the levels of corticosteroids according to need. The levels tend to be much higher in the early morning than later in the day. When the body is stressed, from illness or otherwise, the levels of corticosteroids increase dramatically. Addison’s Overview Addison’s disease can start at any age and affects both men and women equally. In 70% of people with Addison’s disease, the cause is not precisely known, but the adrenal glands are affected by an autoimmune reaction in which the body’s immune system attacks and destroys the adrenal cortex. In the other 30%, the adrenal glands are destroyed by cancer, an infection such as tuberculosis, or another identifiable disease. In infants and children, Addison’s disease may be due to a genetic abnormality of the adrenal glands. Secondary adrenal insufficiency is a term given to a disorder that is similar to Addison’s disease. In this disorder, the adrenal glands are underactive because the pituitary gland is not stimulating them, not because the adrenal glands have been destroyed or have otherwise directly failed. When the adrenal glands become underactive, they tend to produce inadequate amounts of all of the adrenal hormones. Consequently, Addison’s disease affects the balance of water sodium, and potassium in the body, as well as the body’s ability to control blood pressure and react to stress. In addition, loss of androgens, such as dehydroepiandrosterone (DHEA), is thought to be responsible for the loss of body hair in women. In men, testosterone from the testes more than makes up for this loss. DHEA has additional effects that do not relate to androgens. When the adrenal glands are destroyed by infection or cancer, the adrenal medulla and thus the source of epinephrine is lost. However, this loss does not cause symptoms. A deficiency of aldosterone in particular causes the body to excrete large amounts of sodium and retain potassium, leading to low levels of sodium and high levels of potassium in the blood. The kidneys are not able to concentrate urine, so when a person with Addison’s disease drinks too much water or loses too much sodium, the level of sodium in the blood falls. Failure to concentrate urine ultimately causes the person to urinate excessively and become dehydrated. Severe dehydration and a low sodium level reduce blood volume and can culminate in shock. Corticosteroid deficiency leads to an extreme sensitivity to insulin so that the level of sugar in the blood may fall dangerously low. The deficiency prevents the body from manufacturing carbohydrates from protein, fighting infections, and healing wounds very well. Muscles weaken, and even the heart can become weak and unable to pump blood adequately. In addition a person’s blood pressure may become dangerously low. People with Addison’s disease are not able to produce additional corticosteroids when they are stressed. This makes them susceptible to serious symptoms and complications when confronted with illness, extreme fatigue, severe injury, surgery, or, possibly, severe psychological stress. In Addison’s disease, the pituitary gland produces more corticotrophin in an attempt to stimulate the adrenal glands. Corticotrophin also stimulates melanin production, so dark pigmentation of the skin and the lining of the mouth often develop. Symptoms When a person first develops Addison’s disease they feel tired, weak, and dizzy when standing up after sitting or lying down. These problems may develop gradually and insidiously. People with Addison’s disease develop patches of dark skin; this darkness may seem like tanning, but it appears on areas that have not been exposed to the sun. Even people with dark skin can develop excessive pigmentation, although the change may be slightly more difficult to recognize. Black freckles may develop over the forehead, face, and shoulders; a bluish black discoloration may develop around the nipples, lips, mouth, rectum, scrotum, or vagina. Most people lose weight, become dehydrated, have no appetite, and develop muscle aches, nausea, vomiting, and diarrhea. Many become unable to tolerate cold. Unless the disease is severe, symptoms tend to become apparent only during times of stress. Periods of hypoglycemia, with nervousness and extreme hunger, can occur, particularly in children. If Addison’s disease is not treated, severe abdominal pains, noticeable weakness, extremely low blood pressure, kidney failure, and shock may occur (adrenal crisis). An adrenal crisis often occurs if the body is subjected to stress, such as an accident, injury, surgery, or severe infection. Death may quickly follow. Addison’s disease can become present when the adrenal cortex is seriously under active.
* Excessive pigmentation * Black freckles over the forehead, face, and shoulders * Bluish discoloration around the lips, mouth, nipples, rectum, scrotum, and vagina * Depression * Moodiness * Problems dealing with stress * Fatigue * Low blood pressure * Dizziness * Appetite loss * Diarrhea * Nausea * Salty food cravings * Constantly feeling cold Discoloration and darkening of the skin is common in those with Addison’s; discoloration of the elbows, knees, skin folds, scars, and creases in the palms become more noticeable when exposed to the sun. This disease is also characterized by the development of bands of pigment running the length of the nails and darkening of the hair. The most common type of Addison’s is autoimmune Addison’s disease. This happens when the body’s own immune system turns against itself and starts attacking tissue of the adrenal glands, destroying them. It may be associated with other autoimmune disease that affects other endocrine glands. The most common of these is hypothyroidism or under active thyroid. Addison’s disease that coexists with hypothyroidism is known as Schmidt’s syndrome. Less commonly Addison’s occurs together with insulin dependent diabetes mellitus, another autoimmune disease, or insufficiencies of the parathyroid glands and/or gonads, or with pernicious anemia. The bad news is Addison’s disease is a chronic condition that probably will require lifelong treatment. The good new is this disease should not affect your life expectancy if treated correctly. Diagnosis Because the symptoms may be start gradually and be mild, and because no single laboratory test can positively confirm early stage Addison’s disease, doctor’s usually do not suspect it at first. Sometimes a major stress makes the symptoms more obvious and precipitates a crisis. Blood tests may show low sodium and high potassium levels and usually indicate that the kidneys are not working well. A doctor who suspects Addison’s disease measures cortisol levels, which may be low, and corticotrophin levels, which may be high. However, a doctor usually confirms the diagnosis by measuring cortisol levels after they have been stimulated with corticotrophin. If cortisol levels are low, further tests are needed to determine if the problem is Addison’s disease or secondary adrenal insufficiency. Conventional Treatment Regardless of the cause, Addison’s disease can be life threatening and must be treated with corticosterois. Usually treatment can be started with hydrocortisone or prednisone (a synthetic corticosteroid) taken by mouth. However, people who are severely ill may be given cortisol intravenously or intramuscularly at first and then hydrocortisone tablets. Because the body normally produces most of its cortisol in the morning, replacement hydrocortisone should also be taken in divided doses, with the larges dose in the morning. Hydrocortisone will need to be taken every day for the rest of the person’s life. Larger doses of hydrocortisone may be needed when the body is stressed, especially from an illness, and may need to be given by injection f the person has severe diarrhea or vomiting. Most people also need to take fludrocortisones tablets every day to help restore the body’s normal excretion of sodium and potassium. Supplemental testosterone is not usually needed, although there is some evidence that replacement with DHEA improves the quality of life. Although treatment must be continued for life, the outlook is excellent. Suppression of Adrenal Function by Corticosteroids In people who take large doses of corticosteroids, such as prednisone, the function of the adrenal glands can become suppressed. The suppression occurs because large doses of corticosteroids prevent the hypothalamus and pituitary glands from producing the hormones that normally stimulate adrenal function. If the person suddenly stops taking corticosteroids, the body cannot restore adrenal function quickly enough, and temporary adrenal insufficiency (a condition similar to Addison’s disease) results. Also, when stress occurs, the body is not able to stimulate the additional production of corticosteroids that are needed. Therefore, doctors never discontinue the use of corticosteroids suddenly if they have been taken for more than 2 or 3 weeks. Instead, they gradually reduce the dosage over weeks and sometimes months. Also, the dose may need to be increased in people who become ill or otherwise severely stressed while taking corticosteroids. Corticosteroid use may need to be resumed in a person who becomes ill or otherwise severely stressed within weeks of having the corticosteroid tapered and discontinued. Natural Remedies Other treatments for Addison's disease include natural and holistic remedies which can be effective in assisting with the relief of symptoms as well as addressing the individual’s overall health and well being. Herbal and homeopathic remedies are gentle, yet effective - without the harmful side effects of conventional medicine. A combination of herbs such as Borago officinalis (Borage), Eleutherococcus senticosis (Siberian Ginseng) and Astragalus membranaceous (Huang Qi) supports the functioning of the adrenal glands and helps to assist the body to fight the stress of modern day living. Ginger (which stimulates digestion and acts as an anti-nausea aid to treat symptoms of nausea and vomiting) can be beneficial in lessening the symptoms of Addison’s disease. Siberian ginger is particularly effective as a general tonic and helps to relieve physical and emotional stress, while liquorice enhances the activity of mineralocorticoids. Consult a homeopath or herbalist about remedies for your symptoms. Complimentary or Alternative Care Options * Meditation * Yoga * Tai Chi * Acupuncture Suggestion for Coping with Addison’s Disease from Native Remedies People suffering from Addison’s disease can live a productive life but there are certain measures that can be taken to ensure that they cope better. These preventative measures include: * Administer medication daily according to the dosage and directions * Carry a medical identification card or bracelet which will be able to inform medical personnel of your condition and the type of treatment you may need should you be involved in an accident or become acutely ill. * Treat minor illnesses with extra salt and fluid * If you experience fever, vomiting and diarrhea, you need to seek emergency treatment - intravenous saline and hydrocortisone is commonly administered * Increase the intake of salt in your diet * Monitor your weight regularly if you have been vomiting frequently and your appetite has been poor * Monitor your blood pressure regularly because high blood pressure may indicate that your medication needs to be adjusted. If you are feeling lightheaded, your blood pressure may be low * Maintain an open, honest relationship with your doctor where you can freely discuss your symptoms and learn to adjust your medication dosage during times of stress * Join a support group where you can gain information and support from others who have the same condition
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