Addison’s Disease

Overview

What is Addison’s Disease?

Also known as adrenal insufficiency, Addison’s disease is a rare illness in which your adrenal gland does not function correctly. If damaged, the adrenal gland cannot produce enough of the steroid hormones, cortisol or aldosterone. Cortisol is released when the body reacts to stressful situations, whereas aldosterone helps regulate nutrients like sodium and potassium. The adrenal gland also produces androgens or sex hormones. 

Is Addison’s Disease genetic or hereditary?

The exact pattern of inheritance for Addison’s Disease is unknown, but having a family member with Addison’s Disease increases your risk for developing it. 

Is Addison’s Disease fatal, or can it be cured?

Addison’s disease is not curable, but the symptoms can be treated using both medication and lifestyle adjustments. Patients with Addison’s Disease may have to manage bouts of fatigue or be weary of other associated health conditions. Once diagnosed and treated, the prognosis for Addison’s Disease is relatively positive, allowing for a normal life span and an active lifestyle. 

What is the difference between Addison’s Disease and Cushing?

The main difference between Addison’s Disease and Cushing’s Syndrome is the levels of the cortisol hormone. Addison’s Disease is a lack of enough cortisol, whereas Cushing’s syndrome is an excess of cortisol. 

Causes

What are the causes of Addison’s Disease?

Overall, damage to the adrenal glands, which sit atop the kidneys, is the main cause of Addison’s disease. The two major classifications are as follows:

• Primary adrenal insufficiency: This occurs if the adrenal glands are damaged to the point of being unable to produce hormones. This can often occur because of an autoimmune disease. Other causes include:
  • Glucocorticoids used for a prolonged period of time
  • Body infections
  • Cancer or other abnormal growths
  • Some blood thinners used to control blood clotting
• Secondary adrenal insufficiency: This occurs when the pituitary gland, which is in the brain, can no longer produce adrenocorticotropic hormone (ACTH). ACTH is the hormone responsible for controlling the release of hormones from the adrenal gland. Other causes include:
  • Cancer or other abnormal growths
  • Some medications
  • Genetics
  • Traumatic brain injury

What are the risk factors for Addison’s disease?

• If you take blood thinners
• If you have had surgery that was meant to remove any part of the adrenal gland
• If you have an autoimmune disease, like type 1 diabetes or Graves’ disease
• If you have chronic infections such as tuberculosis
• If you have cancer
• If a close family member has Addison’s Disease, this can increase your predisposition to developing Addison’s Disease

Symptoms

What are the symptoms of Addison’s Disease?
Symptoms of Addison’s Disease usually present between the ages of 30 and 50, and are similar to other autoimmune conditions. 

• Severe muscle weakness
• Muscle or joint pain
• Hyperpigmentation (darkened skin color) 
• Unintentional weight loss or decreased appetite
• Gastrointestinal issues like nausea, diarrhea, or vomiting 
• Increased salt cravings
• Fainting spells 
• Low blood pressure 
• Low blood sugar
• Irritability or depressive moods
• Sleep disturbances
• Loss of underarm or pubic hair in women

What is Acute adrenal failure (Addisonian crisis)?

This is a sudden symptom of untreated Addison’s Disease caused by an extremely low level of cortisol. If in an Addisonian crisis, you may also have low blood pressure, high potassium levels (hyperkalemia), and low sodium levels (hyponatremia). This shock can be life-threatening and a doctor should be contacted immediately if you notice any of the following symptoms:

• Pain in the lower half of your body, specifically lower body or legs
• Reduced consciousness, delirium, or confusion
• Severe weakness
• Severe abdominal pain, vomiting and diarrhea, and dehydration

Diagnosis

How is Addison’s Disease diagnosed?
After your doctor asks about your medical history and your symptoms, some of the following tests may be administered:

• Blood test: This test measures the amount of potassium, sodium, cortisol, and adrenocorticotropic hormone (ACTH) in your bloodstream. It can also measure the antibodies that your body would produce if you had autoimmune Addison’s Disease.  
• ACTH stimulation test: This test measures the level of cortisol in your blood after you have been injected with synthetic adrenocorticotropic hormone (ACTH). In a healthy body, ACTH would signal the adrenal glands to produce cortisol. 
• Insulin-induced hypoglycemia test: This is a test to differentiate between primary and secondary adrenal insufficiency. It checks your blood sugar/blood glucose and cortisol levels after an injection of insulin, since typically a healthy response is that glucose levels will fall and cortisol levels will increase. 

Treatment

How is Addison’s Disease treated?

Since Addison’s Disease cannot be cured, treatment is focused on managing the symptoms. 

• Medications need to be taken consistently and likely for life. They can be hormone replacements, meant to make up for the lack of production by the adrenal glands. They can also be glucocorticoid medications meant to reduce inflammation and improve quality of life. 
• Home care may also be advised. This includes having an emergency kit with all necessary medications, a medical alert card in your wallet or bracelet on your wrist, and an injectable corticosteroid for emergencies. 
• Increased stress levels can negatively impact treatment of Addison’s Disease, so alternative therapies to reduce stress levels, like yoga or meditation, may be advised.

References

Macon, B. L. (2019, July 19). Addison’s Disease. Healthline. https://www.healthline.com/health/addisons-disease#diagnosis.

Mayo Foundation for Medical Education and Research. (2020, November 24). Addison’s Disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/addisons-disease/symptoms-causes/syc-20350293.Mayo Foundation for Medical Education and Research. (2021, April 30). Cushing Syndrome. Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/cushing-syndrome/symptoms-causes/syc-20351310.

U.S. Department of Health and Human Services. (n.d.). Addison’s disease. Genetic and Rare Diseases Information Center. https://rarediseases.info.nih.gov/diseases/5740/addisons-disease.U.S. National Library of Medicine. (2020, August 18). Autoimmune Addison Disease. MedlinePlus. https://medlineplus.gov/genetics/condition/autoimmune-addison-disease/#inheritance.