Addison’s Disease (Underactive Adrenal Glands)

Adrenal fatigue has become somewhat of a buzzword in health circles over the past decade. In many instances it is meant to refer to a type of ‘burnout’ of the adrenal glands due to prolonged stress. The adrenal glands sit on top of the kidneys and secrete adrenalin and cortisol, two of the major stress hormones. These hormones also have other benefits which play an integral role in health and wellbeing. However, there is a well established disease of these glands which renders it less active.

What is Addison’s disease?

Addison’s disease also known as chronic adrenal insufficiency is a medical condition where there is inadequate production of steroid hormones by the adrenal glands. This disease is quite rare and is more common among women in the 30 to 50 year age group. It usually presents with non- specific symptoms like pain in the abdomen and generalized weakness. However, under certain stressful situations the disease may evolve into life threatening form known as Addisonian crisis or adrenal crisis. The affected person usually requires lifelong replacement of the steroid hormones along with measures to prevent other health problems that may arise as complications.

Signs and Symptoms

The symptoms of Addison’s disease usually develop gradually over months. It is often ignored in the early stages because it is non0specific like fatigue, poor muscular function due to tiredness, weight loss and loss of appetite. With the development of more serious and obvious symptoms a person may then be prompted to seek medical attention. This includes:

  • Changes in skin color due to increased pigmentation (hyperpigmentation) especially at palmar creases, recent scar areas and genital area.
  • Decline in blood pressure sometimes even sudden blackouts may also occur.
  • Drop in blood sugar.
  • Nausea and vomiting.
  • Craving for salt.
  • Pain in the muscles and joints.
  • Irritability and depression.
  • Change in personality.
  • Loss of body hair.
  • Diminished sexual drive.

Sometimes other medical conditions like type 1 diabetes, underactive thyroid disorders like Hashimoto’s thyroiditis and skin diseases like vitiligo may occur with Addison’s disease. Therefore the symptoms of these diseases may co-exist along with those of Addison’s disease.

Adrenal Crisis

In some severe cases, Addison’s disease may also present as an adrenal or Addisonian crisis. It is a medical emergency and occurs in a previously undiagnosed case of adrenal insufficiency. There is sudden impairment of adrenal function in an otherwise healthy person (adrenal hemorrhage) or due to physiologically stressful situation like infection or trauma. Specific symptoms may include sudden onset excruciating pain in the legs, abdomen or lower back area, severe degree of vomiting and diarrhea which often lead to features of dehydration, fall in blood pressure, confusion, slurring of speech, dizziness, electrolyte imbalance, high fever and  convulsions.

Causes of Addison’s Disease

The adrenal glands are pair of small glands located just above the kidneys. The outer cortex of the gland produces corticosteroid hormones known as glucocorticoids, minerelocorticoids and sex steroids. Both glucocorticoids and minerelocorticoids are essential for survival. Addison’s disease may occur following number of reasons:

  • Primary adrenal insufficiency: The adrenal gland itself is damaged resulting into insufficient hormone production. Common causes are autoimmune disease when the immune system of the body wrongly attacks the adrenal gland, infections like tuberculosis, hemorrhage (bleeding) in the gland or cancer to adrenal glands.
  • Secondary adrenal insufficiency: The ituitary gland produces a hormone know as adrenocorticotrophic hormone (ACTH) responsible for regulating the activity of the adrenal gland (hormone production). Sometimes if ACTH production is inadequate due to diseases or damage of pituitary adrenal gland. Other than inadequate pituitary function sometimes prolonged steroid intake as in asthmatics  and sudden stoppage of the drug may lead to secondary adrenal insufficiency.

Addison’s Disease Treatment

Replacement of the deficient hormone(s) is the main way in which Addison’s disease is treated. This may be in the form of oral or injectable corticosteroids, androgen replacement and so on. Doctors usually recommend a high sodium intake especially during exercise or in hot weather.
Addisonian crisis is managed at hospital with correction of low blood pressure, low blood sugar and high potassium level as it can quickly become fatal.

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