Addisons disease is a disorder of the endocrine system. It is a hormonal disorder that can strike anyone, any gender at any age. Addisons disease has also been called Adrenal Insufficiency (hypocortisolism) because the root of the disease is in the adrenal gland not producing enough of the hormone cortisol, or sometimes not enough of the hormone aldosterone to satisfy the bodys needs. Cortisol is in the class of hormones called glucocorticoids and affects almost every organ in the body.
One of the most important functions of cortisol is to help regulate the bodys response to stress. Cortisol is also responsible for other necessary functions including: helping to maintain blood pressure and cardiovascular functions, helping to slow the immune systems inflammatory response, helping to balance the effects of insulin in breaking down sugars for energy, helping to regulate the metabolism of proteins, carbohydrates, and fats, and helping to maintain proper arousal of sense of well being.
The amount of cortisol is precisely balanced and regulated by the brains hypothalamus. Aldosterone is in a class of hormones called mineralocorticoids which is also produced by the adrenal glands. The main functions of aldosterone are to help to maintain blood pressure and helping the kidneys retain needed sodium and excrete unwanted potassium to maintain the balance of water and salt in the body. When adrenal insufficiency occurs, there are many symptoms that begin gradually and therefore the disease can go undiagnosed for years.
Some of the most common symptoms are chronic fatigue, muscle weakness, loss of appetite, and weight loss. Some symptoms that can also occur in some patients are nausea, vomiting, and diarrhea. The previously mentioned symptoms are fairly common with many different disorders however some of the most defining symptoms of Addisons disease are low blood pressure that drops when standing, and skin changes or hyperpigmentation that is most visible on areas of the body such as scars, knees, elbows, knuckles, lips, and skin folds.
Patients can also suffer from depression, irritability, and a craving for salt, and amenorrhea in female patients. Diagnosing Addisons disease is most accurately done with biochemical laboratory tests which consist of an injection of ACTH then monitoring the ACTH output in a patients urine and/or the levels of ACTH in the patients blood to see how the persons body reacts to the injection. Physicians can also detect Addisons disease by an insulin-induced hypoglycemia test, which monitors how the adrenal glands, the pituitary glands, and the hypothalamus respond to stress.
In this test the patients levels of blood glucose and cortisol are measured over an hour and a half following an injection of fast acting insulin. Physicians may also use test such as x-rays of the adrenal glands to check for calcium deposits that may indicate TB. Physicians my also use different imaging tools such as a CT scan to compare the size and shape of the patients pituitary gland. The pituitary glands of persons suffering from Addisons disease tend to be smaller in size and misshapen than those persons who do not have Addisons disease.
The most common treatment for Addisons disease is hormone replacement therapy. During this treatment, patients are given cortisol and/or aldosterone hormones with similar steroids in order to make up for the hormones that the body is failing to produce on its own. Due to the fact that there is no permanent cure for Addisons disease, once the patients are started on the therapy regimen of replacement hormones, they will more than likely stay on them for the duration of their lives.
If a patient should happen to fall into an addisonian crisis they are instructed to administer an injection of hydrocortisone, saline, and dextrose to bring them out of the crisis. The injection works to replace the cortisol, raise the blood pressure and also raise the blood sugar levels of the patient. Although Addisons disease can be life threatening, it is possible to live a fairly normal life with the proper treatment. President John F. Kennedy was diagnosed with Addisons disease and, with the proper treatment, was one of our countries greatest leaders.
