Typically, to talk about Addison’s disease is to talk about adrenal insufficiency.
First of all, it’s important to know that this disease is very uncommon. After all, the incidence, or new cases, is only 0.83 per hundred thousand people. Thus, that means that the prevalence, or the number of cases in a general population, is only four to six cases per hundred thousand people.
Some time ago, the most common cause of the disease was tuberculosis. This is because this disease affected adrenal glands. Currently, as there’s more control over tuberculosis, the most common cause is ‘idiopathic.’ Therefore, it’s an autoimmune origin in which the body attacks its own organs.
Overall, symptoms can manifest at any age. However, it’s more common at approximately the age of 38. Meanwhile, its peak onset is at 40 years of age. Like many other endocrine disorders, it’s more common among women than among men.
The causes of Addison’s disease
We mentioned above that talking about Addison’s disease is talking about adrenal insufficiency. Thus, you must first understand what the adrenal glands are and what they do in the body.
Humans have two adrenal glands, one above each kidney in the abdominal cavity. Internally, each one of them is made up of two parts:
- Adrenal medulla. This is the internal part of the gland that’s in charge of producing adrenaline-like hormones.
- Adrenal cortex. This is the outer layer of each gland. It’s in charge of producing corticosteroid hormones such as:
- Glucocorticoids. Cortisol is the most well-known. It has metabolic, inflammatory, and stress response functions.
- Mineralocorticoids. Aldosterone is the most well-known of these. It regulates the body’s sodium and potassium levels.
- Androgens. These are male sex hormones.
Essentially, Addison’s disease destroys the cortex of the adrenal glands. Without this cortex, the body lacks cortisol and aldosterone. Overall, the symptoms of the disease come precisely by the lack of these hormones.
The following are causes of the destruction of the adrenal cortex:
- Autoimmune conditions. In these cases, the body attacks the adrenal gland with antibodies.
- Autoimmune polyendocrine syndrome. This is an autoimmune disease in which the body attacks various glands at the same time.
- Infections. These include fungal infections and tuberculosis.
- Tumors of the gland itself, or metastatic cancers from other organs, may also cause this condition.
Symptoms of the disease
In most cases of Addison’s disease, the symptoms become evident slowly. This is why this condition is so hard to diagnose. After all, some people don’t notice the symptoms. Similarly, other symptoms mimic those of other diseases.
The problem with delayed diagnosis is that it can seriously endanger the life of the person who suffers from it. That’s why it’s important to know the symptoms and see a doctor if you suspect you may suffer from them.
The most common symptoms are:
- Loss of appetite
- Skin hyperpigmentation, or darkening in certain areas of the skin
- Low blood pressure
- Hypoglycemia (low blood sugar levels)
- Asthenia (fatigue, lack of strength)
- Muscle aches
Some patients who suffer from this disease develop an acute crisis. Then, several of the symptoms listed above manifest suddenly. Doctors call this “acute adrenal insufficiency.” Unfortunately, it can lead to a deadly shock if they do not treat it properly and immediately. Overall, this is a potentially life-threatening condition.
Diagnosis and treatment
To diagnose Addison’s, doctors must measure hormone levels. Typically, the simplest test consists of measuring cortisol and ACTH hormone blood levels of the patient in the early morning. Generally, a patient with Addison’s disease will have high ACTH blood levels and low cortisol blood levels.
Also, to get more specific results, the medical professional can stimulate natural cortisol. They do this with artificial ACTH and measure the patient’s blood levels before and after stimulation. In patients who suffer from Addison’s disease, cortisol blood levels don’t increase after ACTH stimulation.
If you suspect you may be suffering from this condition, it’s important for you to see your doctor as soon as possible. They may suggest blood cortisol level screening. If the results are inconclusive, they should perform an ACTH stimulation test to confirm or rule out the diagnosis.
Finally, the medical professional may also request blood screening.
Once doctors diagnose the disease, treatment basically consists of artificially replacing the missing hormones.
Finally, to replace cortisol, doctors prescribe synthetic glucocorticoids. Meanwhile, they replace aldosterone with similar steroids, like fludrocortisone. Finally, doctors may also prescribe hormones such as dehydroepiandrosterone to replace androgens.