What is Addison’s disease?

The adrenal glands are located on top of the kidneys. The outer layer of the adrenal glands makes three types of hormones which are essential for body functions:

1. Glucocorticoids such as cortisol are essential for life, helping regulate blood sugar and appetite, your ability to fight infection and your response to stress.
2. Mineralocorticoids such as aldosterone maintain your blood pressure and your body’s balance of sodium and potassium.
3. Androgens, or male sex hormones. They are produced in small amounts in the adrenal glands in both men and women and play a role in general well-being.

Primary adrenal insufficiency, or Addison’s disease, is a rare condition where the adrenal glands cease to function and no longer produce enough cortisol. Usually, the two other types of hormones made by the adrenal glands, aldosterone and androgens are also low. 

 

What causes Addison’s disease?

The most common cause is autoimmune disease, which occurs when the body’s immune system attacks the adrenal glands. The damaged adrenal glands are then unable to produce hormones. Other less common causes of adrenal insufficiency include bleeding in the glands, infections, genetic diseases, cancers and surgical removal of the adrenal glands.

 

What are the symptoms of Addison’s disease?

Symptoms usually develop gradually, often over several months and include:

• Extreme fatigue
• Muscle weakness, muscle and joint pains
• Decreased appetite and weight loss. 
• Nausea, vomiting, abdominal pain and diarrhoea.
• Low blood pressure leading to dizziness upon standing
• Salt cravings 
• Hyperpigmentation – darkened skin on the face, neck and also the natural skin creases such as the palm of the hand creases.

If this is not treated, a life-threatening condition called an adrenal crisis may occur (see below). 

 

How is Addison’s disease diagnosed?

Your doctor will measure blood levels of cortisol and other hormones, as well as electrolytes such as sodium and potassium

They may also look at the adrenal glands with imaging tests, such as CT or MRI scans.

 

How is Addison’s disease treated?

Treatment involves taking hormones to replace those that are missing. You will probably need lifelong daily replacement of hormones. 

• You will be prescribed steroids (hydrocortisone or prednisolone) to replace the cortisol your body no longer makes. 
• You may also need mineralocorticoids (fludrocortisone) if your body does not produce enough aldosterone.

With the right balance of daily medication, people with Addison’s disease can expect to have a normal life span and lead full and active lives.

 

Sick day rules

The adrenal glands normally respond to stress by producing more cortisol. People with Addison’s disease are unable to do that. Extra doses of steroids will therefore be needed during times of stress, such as serious illness or surgery, to compensate.

• Cold with no fever:  no change in steroid dose necessary
• Fever or more severe illness e.g. need to take a day off work: double the steroid dose for 48 hours or until the fever has settled then go back to maintenance dose. If you are unwell after 48 hours then seek medical advice.
• Vomiting, diarrhoea or severe illness: you will need an injection of hydrocortisone into a muscle so make sure you are seen by doctor as soon as possible.

 

You should wear a medic alert bracelet or necklace and/or should carry a steroid card to let others know that you have Addison’s disease and are on steroids.

When visiting the dentist, doctor or hospital please advise them of your condition and let them know that you are on steroids. You will need increased amounts of steroids for any surgery.

 

Adrenal crisis

Acute adrenal failure (adrenal crisis) is life-threatening and requires emergency medical care. The most common sign is shock with very low blood pressure and drowsiness or loss of consciousness. This may be preceded by fever, vomiting and abdominal pain. It usually occurs after infection, illness or injury.

 

For further information

https://www.addisonsdisease.org.uk

 

By Dr Mohgah Elsheikh