Addisions disease

Alternative names    Return to top

Adrenocortical hypofunction; Chronic adrenocortical insufficiency; Primary
adrenal insufficiency
Definition    Return to top
Addison's disease is a hormone deficiency (not enough hormone) caused by
damage to the outer layer of the adrenal gland (the part known as the adrenal
cortex).
Causes, incidence, and risk factors    Return to top
The adrenal glands are small hormone-secreting organs located on top of
each kidney. They consist of the outer portion (called the cortex) and the
inner portion (called the medulla). The cortex produces 3 types of hormones:
glucocorticoid hormones, mineralocorticoid hormones, and sex hormones.
 The glucocorticoid hormones (such as cortisol) maintain glucose
(sugar) control, suppress (decrease) immune response, and help the body
respond to stress.
 The mineralocorticoid hormones (such as aldosterone) regulate
sodium and potassium balance.
 The sex hormones, androgens (male) and estrogens (female) affect
sexual development and reproduction.
Addison's disease results from damage to the adrenal cortex. The damage
causes decreased production of the hormones produced by the cortex. This
damage may be caused by the following:
 The immune system mistakenly attacking the gland (autoimmune
disease)
 Infections such as tuberculosis, HIV, or fungal infections
 Hemorrhage, blood loss
 Tumors
 Use of blood-thinning drugs (anticoagulants)
Risk factors for the autoimmune type of Addison's disease include other
autoimmune diseases:
 Type I diabetes
 Hypoparathyroidism
 Hypopituitarism
 Pernicious anemia
 Testicular dysfunction
 Graves' disease
 Chronic thyroiditis
 Dermatis herpetiformis
 Vitiligo
 Myasthenia gravis
These may be caused by certain genetic defects.
Symptoms    Return to top
 Extreme weakness
 Fatigue
 Unintentional weight loss
 Nausea and vomiting
 Chronic diarrhea
 Loss of appetite
 Darkening of the skin - patchy skin color
o Unnaturally dark color in some locations
o Paleness may also occur
 Mouth lesions on the inside of a cheek (buccal mucosa) -
pigmentation
 Slow, sluggish movement
 Changes in blood pressure or heart rate
 Salt craving
Signs and tests    Return to top
 Blood pressure is low.
 Cortisol level is low.
 Serum sodium is low.
 A potassium test may show increased potassium.
 An abdominal x-ray may show adrenal calcification.
 An abdominal CT scan may show adrenal calcification, enlargement
or atrophy.
 Sex hormone levels will probably remain normal, because these
hormones are also made by the ovaries or testes (and in larger amounts).
This disease may also alter the results of the following tests:
 Renin
 Potassium test
 Cortisol, urine
 CO2
 Aldosterone
 ACTH
 24 hour urinary aldosterone excretion rate
 17-ketosteroids
 17-hydroxycorticosteroids
 Cortrosyn stimulation test (Cortrosyn is a man-made form of part of
the ACTH hormone)
 Blood eosinophil count (a special white blood cell)
Treatment    Return to top
Treatment with replacement corticosteroids will control the symptoms of
this disease. However, these drugs must usually be continued for life.
Usually, people receive a combination of glucocorticoids (cortisone or
hydrocortisone) and mineralocorticoids (fludrocortisone).
Times of stress, infection, or injury may require increased doses of
medications.
Adrenal crisis is an extreme form of symptoms of adrenal insufficiency,
brought on by physical stress. Hydrocortisone must be injected immediately
to sustain life. Supportive treatment for low blood pressure is usually
necessary as well.
Some people with Addison's disease are taught to give themselves an
emergency injection of hydrocortisone during stressful situations. It is
important for the individual with Addison's disease to always carry a
medical identification card that states the type of medication and the proper
dose needed in case of an emergency.
Never skip doses of medication for this condition, as life-threatening
reactions may occur. If you are unable to keep the medication down due to
vomiting, notify your health care provider, go to the emergency room, or call
the local emergency number (such as 911) immediately.
Also report sudden weight gain or fluid retention to your health care
provider.
Expectations (prognosis)    Return to top
With adequate replacement therapy, most people with Addison's disease are
able to lead normal lives.
Complications    Return to top
Complications may result from the following associated illnesses:
 Diabetes
 Thyrotoxicosis
 Hashimoto's thyroiditis (chronic thyroiditis)
 Hypoparathyroidism
 Pernicious anemia
 Ovarian hypofunction or testicular failure
Calling your health care provider    Return to top
Call your health care provider if you have been diagnosed with Addison's
disease, and stress such as infection, injury, trauma, or dehydration occurs.
Medication adjustments may be needed.
Call your provider if your weight increases over time, your ankles begin to
swell, or other new symptoms develop.
If symptoms of adrenal crisis (low blood pressure, diminished
consciousness, difficulty breathing, abdominal pain) occur, give yourself an
emergency injection of your prescribed medication as instructed or -- if this
is not available -- go to the nearest emergency room or call 911.
Update Date: 8/8/2006
 
Cushings syndrome
 
Alternative names    Return to top
Hypercortisolism
Definition    Return to top
Cushing's syndrome is a disease caused by increased production of cortisol,
or by excessive use of cortisol or other steroid hormones.
Causes, incidence, and risk factors    Return to top
Cushing's syndrome is a condition that results from an excess of cortisol, a
hormone produced by the adrenal glands. The most common cause of
Cushing's syndrome is Cushing's disease, caused by excessive production of
the hormone ACTH by the pituitary gland. ACTH stimulates the adrenal
glands to produce cortisol.
Cushing's syndrome can be caused by a tumor of the pituitary gland, a tumor
of the adrenal gland, a tumor somewhere other than the pituitary or adrenal
glands (ectopic Cushing's syndrome), or by long-term use of corticosteroids
(drugs commonly used to treat conditions such as rheumatoid arthritis and
asthma).
Risk factors for Cushing's syndrome are adrenal or pituitary tumors, long-
term therapy with corticosteroids, and being female.
See also:
 Cushing's disease (pituitary Cushing's)
 Cushing's syndrome - exogenous
 ectopic Cushing's syndrome
 Cushing's syndrome caused by adrenal tumor
Symptoms    Return to top
 Moon face (round, red, and full)
 Buffalo hump (a collection of fat between the shoulders)
 Central obesity with protruding abdomen and thin extremities
 Weight gain (unintentional)
 Weakness
 Backache
 Headache
 Acne or superficial skin infections
 Thin skin with easy bruising
 Thirst
 Increased urination
 Purple striations on the skin of the abdomen, thighs, and breasts
 Mental changes
 Impotence or cessation of menses
 Facial hair growth
Additional symptoms that may be associated with this disease:
 Skin spots, red
 Skin blushing / flushing
 Muscle atrophy
 Fatigue
 Bone pain or tenderness
 High blood pressure
Signs and tests    Return to top
Tests to confirm high cortisol level:
 Cortisol, urine
 Dexamethasone suppression test
 Serial serum cortisol levels
Tests to determine the cause:
 ACTH
 Cranial MRI or cranial CT scan may show pituitary tumor
 Abdominal CT may show adrenal mass
General findings:
 Glucose test is elevated
 Potassium test may be low
 White blood cell count may be elevated
Treatment    Return to top
Treatment depends upon the cause of the disorder. In Cushing's syndrome
caused by drug therapy with corticosteroids, the drug dose must be slowly
decreased under medical supervision.
In Cushing's disease caused by a pituitary tumor, surgery to remove the
tumor is recommended. Radiation is sometimes needed as well.
Hydrocortisone (cortisol) replacement therapy is needed after surgery. In
some cases, life-long cortisol-replacement therapy becomes necessary.
Cushing's syndrome caused by an adrenal tumor is usually treated by
surgical removal of the tumor. If the tumor cannot be removed, certain
medications can suppress the secretion of cortisol.
In Cushing's syndrome caused by a tumor secreting ACTH, removal of the
tumor is the best way to treat the Cushing's syndrome. Cortisol replacement
therapy is needed after surgery until cortisol production resumes. In some
cases, life-long therapy with cortisone drugs becomes necessary.
Expectations (prognosis)    Return to top
Tumor removal may lead to full recovery, but there is a chance of
recurrence. Survival for people with ectopic tumors depends upon the
overall outcome associated with the particular tumor type. Untreated,
Cushing's syndrome can lead to death.
Complications    Return to top
 Diabetes
 High blood pressure
 Serious infections
 Fractures due to osteoporosis
 Kidney stones
 Enlargement of pituitary tumor
Calling your health care provider    Return to top
Call your health care provider if symptoms develop that indicate Cushing's
syndrome.
Prevention    Return to top
Cushing's syndrome may be prevented by an awareness of the associated
symptoms so that early detection can be made
Adrenal gland
 
Triangular-shaped glands located on top of the kidneys. They produce
hormones such as estrogen, progesterone, steroids, cortisol, and cortisone,
and chemicals such as adrenalin (epinephrine), norepinephrine, and
dopamine.