Addison’s disease or adrenal insufficiency is a rare disorder in which the adrenal glands are unable to produce adequate amounts of steroid hormones; cortisol and aldosterone.
Cortisol regulates the body’s response to stress, while aldosterone plays an important role in regulating the salt content of the body. This life-threatening situation can occur in both sexes, and in all age groups.
Continuous treatment with steroid replacement is needed to control the symptoms.
Early and appropriate treatment of the condition is very important.
Secondary insufficiency – this form of adrenal insufficiency is caused by damage to the pituitary gland or hypothalamus. These organs produce hormones that regulate the functioning of adrenal glands.
Pituitary glands produce the adrenocorticotropic hormone (ACTH) that stimulates the adrenal glands to produce steroid hormones. Reduced production of ACTH leads to inadequate amounts of cortisol and aldosterone.
Secondary insufficiency may also result from abrupt cessation of corticosteroid drugs, often prescribed for conditions like asthma and arthritis.
3 Making a Diagnosis
Addison’s disease is diagnosed based on medical history and physical symptoms. Some of the tests used in confirming the disorder are:
Blood tests – levels of sodium, potassium, and cortisol in the blood indicate adrenal insufficiency. Addison’s disease is characterized by low levels of sodium and cortisol. Potassium levels remain high. Levels of antibodies are also measured to confirm the disease.
ACTH test – levels of cortisol in the blood are measured before and after administering ACTH. ACTH stimulates adrenal glands to produce cortisol. If adrenal glands are damaged, cortisol levels remain low in blood. This helps to differentiate between primary and secondary adrenal insufficiency.
Insulin-induced hypoglycemia test – levels of blood glucose and hormone cortisol are measured at intervals after introducing insulin. Blood glucose levels fall while cortisol levels increase in a healthy individual.
Imaging techniques – images help to assess size, damage, and other abnormalities in the adrenal glands. If the condition is caused by secondary insufficiency, images of pituitary glands help in diagnosis.
Treatment is based on the actual cause of Addison's disease.
As levels of cortisol and aldosterone are low, hormone replacement therapy is essential. Oral corticosteroids are given to replace cortisol, while fludrocortisone is used to improve levels of aldosterone.
Corticosteroids may also be given in the form of injections, if vomiting increases. The dosage is increased in case of injury, infection, or stress.
Medications are given to control low blood pressure. Sodium supplementation is given for persistent diarrhea and heavy physical exercise.
Addison’s crisis is characterized by low blood pressure, low blood sugar, and high levels of potassium which are treated with injections of hydrocortisone, sugar, and saline.
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