Addison's Disease (Adrenal Insufficiency)

Approved Doctor(s) ; Chris M. Adams , Bartolome Burguera • May 09, 2023

Table of contents

30 Second Summary

  • Addison's disease is a condition in which the adrenal glands fail to produce enough hormones.
  • The adrenal glands produce hormones such as cortisol and aldosterone. These hormones help the body cope with stress, regulate blood pressure and maintain electrolyte balance.
  • Symptoms include fatigue, weakness, weight loss, nausea, vomiting, diarrhea, low blood pressure, darkening of the skin and, in emergency cases, coma.
  • Treatment consists of replacing the missing hormones. Patients should receive hormone replacement therapy for life.

What is Addison's disease (Adrenal Insufficiency)?

Addison's disease, one of the rarest diseases, is also called adrenal insufficiency. Addison's disease, which can be explained as a condition in which certain hormones are not secreted sufficiently in the body, especially the adrenal glands, aldosterone and cortisol hormones secreted by the adrenal glands are below normal values.

Addison's disease, which occurs in all age groups and genders, is a life-threatening disease.

Types of Addison's disease (Adrenal Insufficiency)

Addison's disease is divided into two types. The reason for this diversity is the variation in the area of hormone deficiency.

Primary adrenal insufficiency

It is a type of Addison's disease caused by the deterioration of the cortex of the adrenal glands. It is usually caused by an autoimmune disease in which the immune system attacks healthy body tissues.

For unknown reasons, the immune system attacks the adrenal cortex, causing insufficient secretion of hormones. In addition, patients with Addison's disease are at increased risk of different autoimmune diseases.

Other causes of primary adrenal insufficiency include various types of infection, cancers that metastasize to the adrenal glands, bleeding and tuberculosis. In particular, bleeding in the adrenal glands can cause a sudden Addisonian crisis without symptoms.

Secondary adrenal insufficiency

The hormone ACTH produced by the pituitary gland stimulates the adrenal cortex. However, if the pituitary gland is damaged for any reason, the adrenal cortex is not sufficiently stimulated. In addition to benign pituitary tumors or pituitary gland surgery, androgen and glucorticoid insufficiency produced by the adrenal glands can also occur without any cause. This condition, which occurs in people whose adrenal cortex is not stimulated for various reasons, is called secondary adrenal insufficiency.

Most of the symptoms caused by secondary adrenal insufficiency are similar to those of primary adrenal insufficiency. However, skin darkening is not seen in secondary adrenal insufficiency. It is also less likely to cause severe dehydration or low blood pressure. On the other hand, hypoglycemia is more likely to occur in secondary adrenal insufficiency.

Secondary adrenal insufficiency can also be transient. Patients taking corticosteroids used in the treatment of diseases such as arthritis or asthma suddenly discontinue their medication, causing temporary secondary adrenal insufficiency. For this reason, it should be carried out in accordance with the doctor's advice in order to avoid side effects in drug use.

Symptoms of Addison's disease (Adrenal Insufficiency)

The symptoms of Addison's disease vary. The reason for this is the differentiation of hormones that are not secreted in the body. Therefore, the functions of hormones need to be known in order to understand the symptoms of the disease. For example, since cortisol is a hormone secreted due to stress, it is secreted as the body's response when the body is stressed. It also helps regulate protein, fat and carbohydrate utilization. In addition to controlling inflammation, it controls cardiovascular function and blood pressure.

The hormone aldosterone helps to remove potassium from the kidneys and also helps to reabsorb sodium. In this way, it ensures the electrolyte balance in the body. If aldosterone, a steroid hormone, is not secreted sufficiently, it becomes difficult for the kidneys to keep water and salt levels in balance. This leads to dehydration and low blood pressure.

The symptoms caused by Addison's disease begin to show themselves within a few months. Therefore, symptoms appear slowly. Because of the slow onset of symptoms, they can sometimes be overlooked. The most prominent symptoms seen in Addison's disease are as follows:

  • Hair growth in the armpits and genital areas of women
  • Reduced sweating
  • Depression
  • Other behavioral disorders
  • Irritability
  • Muscle aches
  • Fasting hypoglycemia
  • Pain in the joints
  • Weight loss
  • Severe fatigue
  • Abdominal pain
  • Nausea
  • Fainting
  • Diarrhea
  • Vomiting
  • Low blood sugar
  • Increased need for salt
  • Low blood pressure
  • Darkening of the skin, oral mucosa, nipples, genital area and scars

Causes of Addison's disease (Adrenal Insufficiency)

The root cause of Addison's disease is that the immune system attacks the adrenal glands and causes the tissues to break down. Although this is not the only cause of Addison's disease, other causes include the following:

  • Genetic defects
  • Abnormal accumulation of certain types of protein in tissues
  • Abnormal accumulation of certain types of protein in organs
  • Surgical removal of the adrenal glands for a different disease
  • Bleeding in the adrenal glands
  • AIDS
  • Tumors that cause dysfunction of the adrenal glands
  • Tuberculosis
  • HIV
  • Various fungal infections
  • Trauma or injury to the adrenal glands
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Addison crisis

In an Addisonian crisis, symptoms appear within a short period of time. These crises can be life-threatening. For this reason, patients with Addison's disease should urgently consult health institutions in case of the following symptoms:

  • Pale and moist skin
  • Skin cooling
  • Severe dehydration
  • Feeling of numbness
  • Loss of consciousness
  • Weak and weak muscles
  • Severe vomiting
  • Diarrhea
  • Dizziness
  • Rapid breathing
  • Sweating

In addition, some patients may also experience the following symptoms during an Addisonian crisis:

  • High potassium
  • Low sodium
  • Low blood pressure

Diagnostic methods (tests) for Addison's disease (Adrenal Insufficiency)

In the diagnostic process of Addison's disease, the physicians first obtain information about the patients' complaints and medical history. If Addison's disease is suspected as a result of these questions, patients are asked to undergo a number of tests.

Blood test

In the diagnosis of Addison's disease, patients are first asked for blood tests. These tests look at potassium, sodium, ACTH and cortisol levels. In addition, antibodies related to Addison's disease are also examined to determine whether it is an autoimmune disease.

Insulin-induced hypoglycemia test

Insulin-induced hypoglycemia test is requested from patients, especially when secondary adrenal insufficiency is suspected. In order to perform this test, an insulin injection is first administered. Cortisol and blood sugar levels are then measured in the blood. If insulin-induced hypoglycemia is tested in healthy individuals, the blood glucose level drops after the injection. In addition, cortisol levels increase.

Imaging tests

Various imaging methods are used to examine whether there are any structural abnormalities in the suprarenal glands. Abdominal computed tomography is particularly preferred for this purpose. If Addison's disease is detected as a result of the tests, the pituitary gland should also be screened. For this, an MRI scan is performed.

Addison's disease treatment

Hormone replacement is used to treat Addison's disease. These drugs, which should be used daily, replace the missing hormone in patients. If necessary, aldosterone can be replaced with once-daily fludrocortisone acetate or steroids. Patients should take their medication regularly and in the correct doses. It may take some time to determine the correct dose. However, once the correct dose is determined and patients start taking their medication regularly, they can lead a normal life.

Lifestyle modification for people with Addison's disease (adrenal insufficiency)

Addison's disease is one of the chronic diseases. For this reason, patients need to reorganize their lifestyle according to the disease. The most important points within these regulations are the following:

  • First of all, patients should carry a warning card or wristband with them at all times. Thanks to these alerts, healthcare professionals can understand what kind of care patients need if they need urgent intervention.
  • Patients should carry their medicines with them at all times and keep them within easy reach. Because missing even one dose of medication causes patients to experience serious health problems.
  • Another group of medicines that patients should carry with them at all times is the glucorticoid injection kit. This medicine is used in emergency situations and contains an injectable corticosteroid.
  • Another point that patients should particularly emphasize is their relationship with their physicians. In order to ensure that the doses of medicines taken are correct, patients should be in constant contact with their doctor, and in case of any problems, they should inform the doctor as soon as possible and make the necessary arrangements.
  • Finally, it is important that patients attend their annual check-ups without interruption. This way, the disease can be kept under control.

Addison's disease diet

Addison's patients need to keep stress out of their lives. In addition, a healthy diet also affects their susceptibility to the disease.

  • Addison's patients should not consume coffee, soda, energy drinks or stimulants to relieve fatigue. This is because these drinks contain high levels of caffeine. Caffeine causes excessive stimulation of the adrenal glands. In addition, the high amount of sugar in drinks damages the adrenal glands. The same applies to cigarettes and tobacco products.
  • Addison's patients should also avoid carbohydrates and refined sugar. It is especially important to avoid ready-made foods. Patients with Addison's disease accompanied by diabetes need to pay more attention. Because these foods cause blood sugar levels to deteriorate. Low blood sugar also increases the symptoms of Addison's disease.
  • The debate about salt intake in patients with Addison's disease is still ongoing. However, salt consumption is necessary to control low blood sugar, which is one of the first symptoms of the disease. However, sodium should come from quality sources such as Himalayan or sea salt.
  • Addison's patients are known to have increased salt cravings. Especially patients who sweat a lot should not ignore these requests. It is also important for these patients to consume plenty of water.
  • Being under excessive stress can trigger Addison's disease and cause further damage to the body. For this reason, it is recommended that patients consume more vitamin C during stressful periods. In addition, antidepressant consumption is recommended in stressful times as it will strengthen the immune system. The use of antidepressants helps the body to adapt better to stress and prevents further damage to the adrenal glands. However, a doctor should be consulted for the use of antidepressants.
  • Another vitamin that Addison's patients should take is vitamin B. Vitamin B makes nerve cells healthier. In this way, symptoms from the nervous system are better transmitted. Foods rich in vitamin B include shellfish, village eggs, salmon and sardines.
  • For the immune system to function better, they should pay attention to zinc intake. Zinc helps the immune system as well as the production of hormones that help fight stress. Foods rich in zinc include seafood, spinach, beans and mushrooms.
  • Another point that Addison's patients should pay attention to is adequate magnesium intake. Magnesium-rich foods that calm the nervous system include spinach, nuts, yogurt, bananas, black-eyed peas and avocado.
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