GROUP

C2
Physiology Laboratory
Small Group Discussion
Output

April 13, 2016

[ADRENAL INSUFFICIENCY &

ADDISON’S DISEASE]
By: ASUBARIO, Olufunmilola Omonike; BALADAD, Alvin Bryan; DE JESUS, Chrislou; GURUNG, Man
Bahadur; KALANGEG, Kristie; MAHALEE, Naphitcharak; MONTHATHONG, Thanapol; PANLASIGUI,
Rikkimae Maria; SAMSON, Chino Paolo; SOLONIO, Natalie Keith; VALDEZ, Gregorio
 ADDISON’S DISEASE

Introduction

Addison's disease is a disorder that occurs when your body produces insufficient
amounts of certain hormones produced by your adrenal glands. In Addison's disease,
your adrenal glands produce too little cortisol and often insufficient levels of aldosterone
as well.

Also called adrenal insufficiency, Addison's disease occurs in all age groups and
affects both sexes. Addison's disease can be life-threatening. Treatment for Addison's
disease involves taking hormones to replace the insufficient amounts being made by
your adrenal glands, in order to mimic the beneficial effects produced by your naturally
made hormones.

The Adrenal Glands

Adrenal Glands are small hormone-releasing organs located on top of each

kidney. They are made up of an outer portion, called the cortex, and an inner portion,
called the medulla.

The cortex produces three hormones:

 Glucocorticoid hormones (such as cortisol) maintain sugar (glucose) control,
decrease (suppress) immune response, and help the body respond to stress.
 Mineralocorticoid hormones (such as aldosterone) regulate sodium and potassium
balance.
 Sex hormones, androgens (male) and estrogens (female), affect sexual
development and sex drive.

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Primary adrenal insufficiency

Addison's disease occurs when the cortex is damaged and doesn't produce its
hormones in adequate quantities. Doctors refer to the condition involving damage to the
adrenal glands as primary adrenal insufficiency.

The failure of your adrenal glands to produce adrenocortical hormones is most

commonly the result of the body attacking itself (autoimmune disease). For unknown
reasons, your immune system views the adrenal cortex as foreign, something to attack
and destroy.

Other causes of adrenal gland failure may include:

 Tuberculosis
 Other infections of the adrenal glands
 Spread of cancer to the adrenal glands
 Bleeding into the adrenal glands, which may present as adrenal crisis without any
preceding symptoms.

Secondary adrenal insufficiency

Adrenal insufficiency can also occur if your pituitary gland is diseased. The
pituitary gland makes a hormone called adrenocorticotropic hormone (ACTH), which
stimulates the adrenal cortex to produce its hormones. Inadequate production of ACTH
can lead to insufficient production of hormones normally produced by your adrenal
glands, even though your adrenal glands aren't damaged. Doctors call this condition
secondary adrenal insufficiency.

Another more common cause of secondary adrenal insufficiency occurs when

people who take corticosteroids for treatment of chronic conditions, such as asthma or
arthritis, abruptly stop taking the corticosteroids.

Addisonian crisis is a serious medical emergency caused by extremely low

levels of cortisol.

The causes of an Addisonian crisis

 Severe physical shock, e.g. a car accident
 Severe infection, e.g. flu with a high temperature
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  Severe dehydration, e.g. stomach bug with vomiting
The symptoms of an Addisonian crisis
 Extreme weakness
 Mental confusion
 Extreme drowsiness, in advanced cases slipping towards a coma
 Pronounced dizziness
 Nausea and/or vomiting
 Severe headache
 Abnormal heart rate – either too fast or too slow
 Abnormally low blood pressure
 Feeling extremely cold
 Possibly a fever
 Possibly abdominal tenderness

Classic darkening of the skin due to increased pigment as seen in Addison's disease

Possible Complications
Complications can occur if you take too little or too much adrenal
hormone.Complications also may result from the following related illnesses:

 Diabetes
 Hashimoto thyroiditis (chronic thyroiditis)
 Hypoparathyroidism
 Ovarian hypofunction or testicular failure
 Pernicious anemia
 Thyrotoxicosis

Causes

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 Addison disease results from damage to the adrenal cortex. The damage causes
the cortex to produce hormone levels that are too low.

This damage may be caused by the following:

 The immune system mistakenly attacking the adrenal glands (autoimmune
disease)
 Infections such as tuberculosis, HIV, or fungal infections
 Hemorrhage into the adrenal glands
 Tumors

Risk factors for the autoimmune type of Addison disease include other autoimmune
diseases:
 Chronic thyroiditis
 Dermatis herpetiformis
 Graves' disease
 Hypoparathyroidism
 Hypopituitarism
 Myasthenia gravis
 Pernicious anemia
 Testicular dysfunction
 Type I diabetes
 Vitiligo

Diagnosis

 Blood test. Measuring your blood levels of sodium, potassium, cortisol and ACTH
gives your doctor an initial indication of whether adrenal insufficiency may be
causing your signs and symptoms. A blood test can also measure antibodies
associated with autoimmune Addison's disease.

 ACTH stimulation test. This test involves measuring the level of cortisol in your
blood before and after an injection of synthetic ACTH. ACTH signals your adrenal
glands to produce cortisol. If your adrenal glands are damaged, the ACTH
stimulation test shows that your output of cortisol in response to synthetic ACTH is
limited or nonexistent.

 Insulin-induced hypoglycemia test. Occasionally, doctors suggest this test if

pituitary disease is a possible cause of adrenal insufficiency (secondary adrenal
insufficiency). The test involves checking your blood sugar (blood glucose) and

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 cortisol levels at various intervals after an injection of insulin. In healthy people,
glucose levels fall and cortisol levels increase.

 Imaging tests. Your doctor may have you undergo a computerized tomography
(CT) scan of your abdomen to check the size of your adrenal glands and look for
other abnormalities that may give insight to the cause of the adrenal insufficiency.
Your doctor may also suggest an MRI scan of your pituitary gland if testing
indicates you might have secondary adrenal insufficiency.

Treatment
All treatment for Addison's disease involves hormone replacement therapy to
correct the levels of steroid hormones your body isn't producing. Some options for
treatment include:

 Oral corticosteroids. Hydrocortisone (Cortef), prednisone or cortisone acetate

may be used to replace cortisol. Your doctor may prescribe fludrocortisone to
replace aldosterone.

 Corticosteroid injections. If you're ill with vomiting and can't retain oral
medications, injections may be needed.

References:
1. Guyton, AC; Hall, JE: Textbook of Medical Physiology, 11 th edition. Elsevier Inc.
2006.

2. Koeppen, BM; Stanton, BA: Berne and Levy Physiology, 6 th edition. Elsevier Inc.
2010.

3. en.wikipedia.org

4.http://www.mayoclinic.org/diseases-conditions/addisons-disease/diagnosis-
treatment/treatment/txc-20156064

5.https://www.nlm.nih.gov/medlineplus/ency/article/000378.htm

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