A middle-aged man in his 40s began to notice dark discoloration on his skin. He was constantly fatigued and had muscle weakness. He lost his appetite and gradually started losing weight. One morning he experienced nausea and became unconscious. He was taken to the hospital, where a doctor diagnosed him with Addison’s disease.
Understanding Addison’s disease
The body’s endocrine system is composed of glands located throughout the body that release hormones into the bloodstream. These hormones are responsible for regulating a variety of bodily processes and activities, such as mood, metabolism, development, and tissue function. One of the most prominent endocrine glands in the body are the adrenal glands, located above the kidneys and they release hormones such as cortisol, which assists the body in managing stress and maintaining electrolyte balance. When cortisol levels are insufficient, a condition known as Addison’s disease can occur, which is also referred to as hypocortisolism or adrenal insufficiency.
The discovery of Addison’s disease
Thomas Addison, a renowned British physician and scientist, was the first to describe Addison’s disease in 1855. Addison was a devoted physician at Guy’s hospital, dedicating his life to educating students and treating patients. Dr. Thomas Addison will forever be remembered for his contributions to medicine.
Causes
In a condition called primary adrenal failure, the adrenal glands are damaged, which interferes with hormone production. Primary adrenal failure is caused by autoimmune disease, where antibodies that normally fight diseases mistakenly target and destroy the adrenal glands.
Other contributing factors to adrenal gland dysfunction include infections that affect the adrenal glands, tuberculosis, adrenal gland cancer, fungal infections, HIV, hemorrhage, tumors, anticoagulant use, and adrenal gland bleeding.
In secondary adrenal insufficiency, which may be caused due a pituitary gland disease, the body’s adrenal glands are unable to produce sufficient amounts of hormones. The pituitary is located in the vicinity of the brain and is responsible for stimulating adrenal glands to produce hormones. When the body abruptly stops taking medications containing corticosteroids, temporary adrenal deficiency may occur. Furthermore, if Addison’s disease is not treated, it can lead to an addisonian crisis, which is a condition caused by illness, infection, or injury.
Symptoms
A person with Addison’s disease may experience a range of symptoms, including exhaustion, muscle weakness, loss of appetite, skin discoloration, low blood sugar levels, salty food cravings, nausea, vomiting and diarrhea. Additionally, they may experience dizziness, joint pain, depression, and irritability. In acute adrenal failure, the patient may experience pain in their lower back that spreads to their abdomen and legs. Additionally, their blood pressure may drop below the normal range and they may faint. As a result of continuous vomiting and diarrhea, dehydration may occur. Hyperkalemia is a condition in which potassium levels increase in the body.
Diagnosis
Blood tests are used to measure potassium levels, sodium levels, cortisol levels, adrenocorticotropic hormone (ACTH) levels, and to check for antibodies. In ACTH stimulation test, the doctor injects synthetic ACTH in the blood. The ACTH prompts the adrenal gland to produce cortisol hormones. If your adrenal glands don’t respond, it means that your adrenal glands are damaged. If your doctor suspects that you have pituitary gland disease, then you will need to take an insulin induced hypoglycemia test. This test checks your cortisol levels and blood sugar levels. The cortisol levels will rise while the blood sugar levels will fall in a healthy individual. You will also need imaging tests including a computerized tomography (CT) or magnetic resonance imaging (MRI) to check for abnormalities in your adrenal glands.
Treatment
The primary objective of the treatment is to rectify the steroid hormone imbalance. Oral medications may be prescribed to treat the condition. Corticoid injections may be administered, if you are unable to take oral medications.
In the event of a life-threatening condition known as addisonian crisis, emergency medical care is given. This condition is characterized by a decrease in blood sugar levels, a decrease in blood pressure, and a rise in potassium levels. Intravenous injections of saline, hydrocortisone and sugar (dextrose) are administered.
Preparing for a medical emergency
In the event of a medical emergency, it is essential to be adequately prepared. It is recommended to always carry additional oral medications. After consultation with your physician keep an injectable corticosteroid for emergency use. Additionally, wear a bracelet and carry a medical alert card.