Addisons Disease Causes Symptoms Diagnosis And Treatment
Posted By HealthcareOnTime Team
Posted on 2022-01-31
Addison's disease also known as primary adrenal
insufficiency or hypoadrenalism is a rare
disease caused due to hypofunctioning of the
adrenal glands which are located just above the
kidneys. The adrenal glands are responsible for the
production of hormones namely cortisol and
aldosterone. Addison's disease is caused due to lower
production of these hormones which could arise due to
multiple reasons. These causes may include
autoimmune destruction of the adrenal cortex,
response to Tuberculosis (TB) infection or amyloidosis.
Cortisol is the body's "Stress" hormone. It is known for
its function in the body's "Fight or Flight" response and
also, aids in maintaining the rate of metabolism in the
body. It has been shown to have anti-inflammatory
effects as well. Aldosterone, on the other hand, is known
for regulating the salt balance of the body by increasing
the resorption of Sodium ions and water into the kidney
causing increased secretion of potassium ions. A
decrease in the production of these hormones can cause
various effects on the body like hypotension, skin,
pigmentation, anorexia (loss of appetite), weight loss,
fatigue and Depression .
Let us briefly examine the causes of Addison's disease
followed by its symptoms, complications, diagnosis and
Causes of Addison's disease
Addison's disease is primarily caused due to deficiency in the hormones produced by the
adrenal gland; i.e. glucocorticoid cortisol and mineralocorticoid aldosterone. This condition
arises due to production of autoantibodies against the cells on the outer layer of the adrenal
gland (adrenal cortex), leading to disruption in production of the key hormones. This is one
of the leading causes for the development of this condition. The other causes that may be
responsible for the development of this disease include disruption of the adrenal gland caused
due to granuloma development (due to TB or histoplasmosis), tumour or hemorrhage. Also,
administration of certain drugs like ketoconazole used for blocking synthesis of corticosteroids
may be responsible for Addison's disease.
In case of mineralocorticoid deficiency, elevated levels of sodium ions are excreted,
while excretion of potassium ions is lowered. Thus, there is excessive water loss leading
to dehydration, acidosis, hypotension and finally, circulatory collapse. In case of glucocorticoid
deficiency, the body's metabolism of carbohydrates, fats and proteins is disturbed. Absence
of cortisol leads to insufficient production of carbohydrates from proteins, causing hypoglycemia
and lower levels of glycogen in the liver Impaired neuromuscular function causes tiredness
followed by weakened heart muscles and dehydration leading to circulatory failure.
Symptoms of Addison's disease
These constitute the early signs and symptoms of Addison's disease. This is followed by:
- Hyperpigmentation characterised by diffused tanning of the exposed portions of the body,
and to a lower extent unexposed portions like skin folds and scars
- Anorexia (loss of appetite)
The later stages of Addison's disease are characterised
- Weight loss
Complications in Addison's disease
In case not diagnosed on time, there could arise a medical emergency condition termed
as Addisonian crisis which may lead to coma and can become fatal. This condition may
occur if the levels of cortisol suddenly drops too low. When not diagnosed on time or misdiagnosed,
the affected patient is suddenly exposed to a highly stressful episode like a surgery, severe injury
or infection, etc. Under conditions of such stress, the body ameliorates by producing cortisol.
However, due to this condition, the body becomes incapable of coping up with the increased
demand for cortisol and hence likelihood for development of Addisonian crisis rises. This condition
may also arise if there is excessive loss of salt from the body either due to bleeding or sweating
There could be other possible complications that could arise which are as follows:
- Cardiac arrest which occurs if the heart stops functioning completely
- Stroke if there is an interruption in blood supply to the brain
- Hypovolaemic shock which occurs if there is severe blood and fluid loss
- Hypoxia may occur if the body tissues do not get enough oxygen
Diagnosis of Addison's disease
On approach to a physician post symptom onset, past medical records and history of
the patient is first recorded. Symptoms like hyperpigmentation in the skin and gums is
generally the first indication for a physician to suspect Addison's disease. Biochemically,
higher potassium levels (hyperkalemia) and lower sodium levels (hyponatremia) are positive indicators for Addison's disease.
Serum cortisol level estimation also acts as a fair indicator for this condition. Lower levels
of cortisol coupled with increased levels of adrenocorticotropin hormone (ACTH) is the
best positive indicator for Addison's disease. Another test called the "synacthen
test" aids in assessing functioning of the adrenal
glands. This test involves use of a chemical "synacthen"
(analog of ACTH) in order to stimulate the adrenal
cortex to produce the hormones. Low levels of cortisol
even post artificial stimulation is an indicator for
Addison's. Other alternatives for diagnosis include X. rays,
ultrasound and CT scans of the abdominal region to check for visible signs of damage .
Thyrocare Technologies Limited provides testing options for serum electrolytes
(sodium & potassium) using the technology of Ion Selective Electrode (ISE).
Testing options are also available for measuring serum levels of cortisol using
the Chemiluminescence technology (CLIA) and ACTH using technology of Liquid
Chromatography-Mass Spectrometry (LC-MS).
Treatment Options in Addison's disease
The best way to treat Addison's disease is to include regular supplementation with
corticosteroids (both cortisol and aldosterone). These medications are required to
be taken throughout life, and missing doses can lead to severe complications which
can become fatal. At times of Addisonian crisis, hydrocorticosterone must be administered
delay. Patients suffering from this condition are advised Addison's disease.
to carry their medical identity cards stating that they
have adrenal insufficiency. This ID card should contain
information about the type of medication as well as its
dosage, in case of an emergency situation.
The treatment recommendations designed varies from
one patient to another and is highly individualised. In
case of occurrence of any sudden stressful event, these
treatment plans may need alterations which should be
taken care of. Thus, timely and adequate hormone
replacement therapy will aid in better management of
this condition to lead a symptom-free life.