What Is Addison’s Disease?
July 17, 2009
Addison’s disease or adreno-cortical insufficiency is the disease of the kidney caused due to the destruction of the adrenal cortices leading to deficiencies of mineralo-corticoids, gluco-corticoids as well as sex hormones. The disease is seen in all ages. Females are 3 times more affected than men.
Causes
The most common causes for this disease are withdrawal of chronic steroid therapy or atrophy of the adrenal gland. Almost 75% of the cases are due to autoimmune destruction of the adrenals (Schmidt syndrome). Autoimmune hypothyroidism is also associated in majority of the cases. Family history is positive in about 40% of the cases. Other cause may include extra-pulmonary tuberculosis and AIDS has also recently entered the list.
Symptoms
The symptoms include weakness, fatigue, weight loss, hyper-pigmentation of the skin and dehydration. Pigmentation is worst in the skin creases or folds and occasionally depigmentation may also be present. Skin changes may be absent in autoimmune induced disease. Other symptoms may include muscular cramps or pain, new skin scars, joint pains, vitiligo, diarrhoea, constipation, low cold tolerance and weight loss.
Adrenal (or addisonian) crisis is an acute illness that presents with ill-defined upper abdominal pain, nausea, vomiting, hypotension, hypoglycemia, hypokalemia, hyponatremia, lethargy, confusion, disorientation etc. This may be precipitated by infection, trauma, surgery, salt loss, renal shutdown, severe abdominal pain or subnormal temperature.
Sudden adrenal insufficiency leads to fever, abdominal pain, heart enlargement and vascular collapse (shock) that may prove life threatening.
50% of the patients with autoimmune Addison’s disease develop another autoimmune disease like Grave’s disease, pernicious anaemia etc and about 5% of the women develop premature ovarian failure. Hence, the review must be regularly done in case of any possibility of the above symptoms.
Treatment
The patient is to be referred to an endocrinologist at the earliest. Gluco-corticoid and mineralo-corticoid replacement is done in the patients. Appropriate treatment for the underlying cause such as tuberculosis, hypertension is a must.
Diet must balance the sodium and potassium intake. The patient must wear some medical identification (warning bracelet) with information about the disease for emergency situations.
The patient has to be kept under life long supervision. With adequate therapy, life expectancy gets normal. However, there are no preventive measures for the disease.
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