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Book: Mayo Clinic Family Health Book, 5th Edition
Book: Mayo Clinic Family Health Book, 5th Edition
Book: Mayo Clinic Family Health Book, 5th Edition
Addison's disease occurs in all age groups and both sexes, and can be life-threatening.
Treatment involves taking hormones to replace those that Book: Mayo Clinic Family
Health Book, 5th Edition
Symptoms
Addison's disease symptoms usually develop slowly, often over several months. Often,
the disease progresses so slowly that symptoms are ignored until a stress, such as
illness or injury, occurs and makes symptoms worse. Signs and symptoms may include:
Extreme fatigue
Salt craving
Abdominal pain
Irritability
Sometimes the signs and symptoms of Addison's disease may appear suddenly. Acute
adrenal failure (addisonian crisis) can lead to life-threatening shock. Seek emergency
medical treatment if you experience the following signs and symptoms:
Severe weakness
Confusion
See your doctor if you have common signs and symptoms of Addison's disease, such
as:
Severe fatigue
Lightheadedness or fainting
Salt cravings
Causes
Addison's disease is caused by damage to your adrenal glands, resulting in not enough
of the hormone cortisol and, often, not enough aldosterone as well. Your adrenal glands
are part of your endocrine system. They produce hormones that give instructions to
virtually every organ and tissue in your body.
Your adrenal glands are composed of two sections. The interior (medulla) produces
adrenaline-like hormones. The outer layer (cortex) produces a group of hormones called
corticosteroids. Corticosteroids include:
When the cortex is damaged and doesn't produce enough adrenocortical hormones, the
condition is called primary adrenal insufficiency. This 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. People with
Addison's disease are more likely than others to have another autoimmune disease as
well.
Tuberculosis
Bleeding into the adrenal glands. In this case, you may have an addisonian crisis
without any previous symptoms.
Too little ACTH can lead to too little of the glucocorticoids and androgens normally
produced by your adrenal glands, even though your adrenal glands themselves aren't
damaged. This is called secondary adrenal insufficiency. Mineralocorticoid production is
not affected by too little ACTH.
A temporary cause of secondary adrenal insufficiency occurs when people who take
corticosteroids (for example, prednisone) to treat chronic conditions, such as asthma or
arthritis, stop taking the corticosteroids all at once rather than tapering off.
Complications
Addisonian crisis
If you have untreated Addison's disease, you may develop an addisonian crisis as a
result of physical stress, such as an injury, infection or illness. Normally, the adrenal
glands produce two to three times the usual amount of cortisol in response to physical
stress. With adrenal insufficiency, the inability to increase cortisol production with stress
can lead to an addisonian crisis.
An addisonian crisis is a life-threatening situation that results in low blood pressure, low
blood levels of sugar and high blood levels of potassium. You will need immediate
medical care.
Prevention
Addison's disease can't be prevented, but there are steps you can take to avoid an
addisonian crisis:
Talk to your doctor if you always feel tired, weak, or are losing weight. Ask about
having an adrenal shortage.
If you have been diagnosed with Addison's disease, ask your doctor about what
to do when you're sick. You may need to learn how to increase your dose of
corticosteroids.
If you become very sick, especially if you are vomiting and you can't take your
medication, go to the emergency room.
Some people with Addison's disease worry about serious side effects from
hydrocortisone or prednisone because they know these occur in people who take these
steroids for other reasons.
iagnosis
Your doctor will talk to you first about your medical history and your signs and
symptoms. You may undergo some of the following tests:
Blood test. Tests can measure your blood levels of sodium, potassium, cortisol
and adrenocorticotropic hormone (ACTH), which stimulates the adrenal cortex to
produce its hormones. A blood test can also measure antibodies associated with
autoimmune Addison's disease.
CT scan
MRI
Treatment
All treatment for Addison's disease involves medication. You will be given hormone
replacement therapy to correct the levels of steroid hormones your body isn't producing.
Some options for treatment include oral corticosteroids such as:
You will need to get plenty of salt (sodium) in your diet, especially during heavy
exercise, when the weather is hot or if you have gastrointestinal upsets, such as
diarrhea.
Your doctor will also suggest a temporary increase in your medication dosage if your
body is stressed, such as from an operation, an infection or a minor illness. If you're ill
with vomiting and can't keep down oral medications, you may need injections of
corticosteroids.
Corticosteroids
Saline solution
Sugar (dextrose)
Future treatment may eventually involve using adrenocortical stem cells combined with
immunomodulatory treatment — modifying the immune response or the immune system
— as well as gene therapy.
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means
to prevent, detect, treat or manage this disease.
Support groups are available through the National Adrenal Diseases Foundation.
You're likely to start by seeing your family doctor or a general practitioner. However,
when you call to set up an appointment, you may be referred to an endocrinologist.
Because appointments can be brief, and because there's often a lot of ground to cover,
it's a good idea to be well-prepared for your appointment. Here's some information to
help you get ready for your appointment, and what to expect from your doctor.
Write down any symptoms you're experiencing, including any that may seem
unrelated to the reason for which you scheduled the appointment.
Other than the most likely cause, what are possible causes for my symptoms or
condition?
I have other health conditions. How can I best manage them together?
Are there any brochures or other printed material I can take home with me? What
websites do you recommend?
In addition to the questions you've prepared to ask your doctor, don't hesitate to ask
questions during your appointment.
Your doctor is likely to ask you a number of questions. Being ready to answer them may
reserve time to go over any points you want to spend more time on. Your doctor may
ask: