What is Addison’s disease, and what causes it?
While Addison’s disease is considered to be primary failure of the adrenal cortex to produce corticosteroids needed for response to stress, it is not the ONLY Addison’s disease.
First, Addison’s disease of the adrenal gland was most often the result of destruction of the adrenal glands from infection with tuberculosis, which has an avidity for parts of the body with the highest levels of oxygen (upper lobes of the the ß, gonads, adrenal glands, larynx, et al.). So, Addison’s disease was rarely the primary failure of the adrenals but a consequence of infection.
Second, Addison also described pernicious anemia, a failure of blood formation from the lack of “intrinsic factor” necessary for the absorption of vitamin B-12 from the diet. The lack of this substance, usually produced in the stomach, will lead to anemia in a complex cascade of effects.
What are the symptoms of Addison’s disease?
The damage to the adrenal glands can happen slowly, and so Addison’s disease tends to develop at a slow rate and can take several months. Since the symptoms are not noticeable or misconstrued at first, the disease can advance to a more critical stage where symptoms become more intense before they may take it seriously enough to get diagnosed.
The most chronic stage of symptoms is called the “Adrenal Crisis,” or “Addisonian Crisis, “or “Acute Adrenal Insufficiency, “which happens when Addison’s disease is untreated for a long time, even when the more intense symptoms have begun to show. This stage is critical and life-threatening and can quickly lead to a permanent disability, shock, coma, or death if professional medical help is not involved fast enough.
Initial symptoms may include:
•Lethargy, fatigue, and tiredness.
•Weak muscles
•Dehydration and frequent thirstiness
•Frequent urination
•Salt cravings
•Lack of appetite
•Mood swings, irritability, and depression.
•Sleeplessness
•Weight loss
Later symptoms may include:
•Abdominal pains
•Muscle and joint pains and cramps
•Cold sensitivity
•Nausea and vomiting
•Diarrhea
•Mouth sores
•Dizziness, lightheadedness, and drowsy feelings.
•Fainting spells
•Low blood pressure
•Reduced heart rate
•Hypoglycemia; low blood sugar
•Hyperpigmentation; discoloration or darkening of the skin in areas such as the joints, palms, lips, gums, scars, etc.
•Alopecia
•Reduced sexual libido
•Sexual dysfunction in females; menstrual irregularity or seizure.
Addisonian crisis symptoms include:
•Severe dehydration
•Agitation, fear, and delirium
•Confusion and restlessness
•Hallucinations
•Cold shivers
•Pale and clammy skin
•Profuse sweating
•Severe diarrhea and vomiting
•Migraine
•Dizziness
•Rapid, heavy, and shallow breathing
•Weakness
•High fever
•Chronic abdominal, leg, and back pains.
•Faint feeling
•Reduced or loss of consciousness.
How does having Addison’s disease affect your life?
I don’t have Addison’s disease. I have hypopituitarism and don’t produce ACTH. Because of that my body cannot make cortisol. It is treated the same way Addison’s disease is treated, with replacement hormones. I take hydrocortisone and fludrocortisone daily as a result.
In some ways it really doesn’t affect your life much. Many days can go by and I only need my normal daily dose of cortisol. Those times my life doesn’t seem very different from any other person’s life (except for when my alarm goes off to tell me a dose of cortisol is due). In others ways it impacts my life a lot.
Things I have to monitor and/or try to avoid if possible:
1.Stress
2.Dehydration
3.Diarrhea
4.Vomiting
5.Strong emotions
6.Illness
7.Physical injuries
8.Physical exercise
All of those things require more cortisol, some more than others. Effectively, I must live my life being ever present to what is going on and pay attention to my body’s cortisol needs.
If you must have surgery you need much more cortisol for a time. The type of surgery will dictate just how much extra and how long you need it increased.
I have to watch my blood pressure. If it starts dropping I need more cortisol and maybe more fludrocortisone, too, ASAP.
I have to be able to know from what is going on in my life if I need more cortisol for anything.
My doctor gives me guidelines as to how much extra to take and when. But on a day to day basis it is up to me to make sure I have taken enough extra cortisol if it is needed.
If you called your doctor every time you thought you might need more you would probably not have that doctor treating you for very long. You have to learn how to handle things on your own. Run it past your doctor the next time you see them but unless the situation has never happened before you really should know what to do and do it with no more input from your doctor.
I have to wear a medic alert bracelet so first responders will be aware of my need for cortisol. If in an accident I’m going to need a stress dose of cortisol or more.
I have to carry an emergency, injectable stress dose of cortisol wth me at all times in case it is needed to stop an adrenal crisis. I have to be aware of what the symptoms of an adrenal crisis are and if I cannot manage it must get to an ER ASAP. (A cortisol crisis comes in stages. If you catch it in the first stage and take enough extra cortisol you won’t have to go to the ER.) If I have to use my emergency cortisol injection I must go to an ER immediately.
I mostly can’t use anything but an ER now. Urgent care facilities aren’t equipped to handle a cortisol situation. Anything that would cause you to seek out medical care promptly is going to be something that your body needs extra cortisol to handle. So you have to go to an ER who can handle an unstable cortisol situation.
Addison’s disease treatments
Impairment of the adrenal glands is known as Addison’s disease. It can be treated with cortisol and, if necessary, aldosterone as fludrocortisone. High salt diets may be recommended. Epinephrine may also be needed by some patients.