Addison’s disease (primary adrenal insufficiency) – symptoms, causes and treatment of the disease

Proven content

Addison’s disease (primary adrenal insufficiency) is a disorder of the endocrine system caused by a lack of hormones produced by the adrenal glands. Symptoms of Addison’s disease are weakness, low blood pressure and inability to exercise.

Addison’s Disease Definition

Addison’s disease is an endocrine system disorder caused by primary adrenal insufficiency. Damage to the adrenal glands leads to a deficiency of the hormones they produce, resulting in the symptoms of Addison’s disease. The destruction of the adrenal glands most often occurs due to an autoimmune disease – inflammation of the adrenal cortex.

The adrenal glands

The adrenal glands are a paired organ that is located on both sides of the kidneys. The cause of Addison’s disease is closely located in them, and more precisely in the adrenal cortex (external part). The primary symptoms of Addison’s disease can become active during stressful situations or during exercise, because then a person has the greatest deficiency of hormones that “shift the body to a higher gear”. The hormone secreted by the cortex is:

1. cortisol, which affects metabolism, is the body’s response to a stressful situation, disease and rising blood sugar levels,
2. aldosterone, which regulates blood pressure and volume.

The causes of Addison’s disease

Choroba Addisona jest schorzeniem występującym stosunkowo rzadko, częściej chorują na nią kobiety niż mężczyźni. Dlaczego? Kobiety częściej chorują na procesy autoimmunologiczne, które stanowią główną przyczynę choroby Addisona. Choroba pojawiają się najczęściej w trzeciej i czewartej dekadzie życia. The most common causes of Addison’s disease are:

1. bleeding into both adrenal glands
2. adrenal tuberculosis (now a rarer cause of Addison’s disease)
3. infectious diseases (mycoses or AIDS),
4. rak, a szczególnie przerzuty do nadnerczy,
5. autoimmune processes with the consequent destruction of the adrenal glands. This happens when our body produces an antibody that normally destroys a foreign body. In this case, due to a bug, the antibodies attack their own cells (adrenal cells), leading to the destruction of the organ,
6. adrenalektomia, czyli usunięcie obu nadnerczy,
7. congenital disorders,
8. starch,
9. hemochromatoza,
10. Addison’s disease can coexist with other diseases, such as Hashimoto’s, type 1 diabetes in Schmidt’s syndrome or with vitiligo, and hypoparathyroidism in Blizzard’s syndrome.

Addison’s Disease – Symptoms

Injured adrenal glands show failure characterized by:

1. muscle weakness
2. inability to carry out increased physical effort,
3. severe emaciation,
4. chestnut (brown) color of the palms, skin and mucous membranes,
5. low pressure,
6. disturbances in metabolism and functioning of the sex glands.

Bardzo często powyższym objawów towarzyszą:

1. nausea and vomiting
2. disturbances in the regularity of passing stools,
3. sometimes also severe paroxysmal abdominal pain,
4. patients are initially nervous, then depressed, suffer from insomnia,
5. there is also a fever.

A diagnosis of Addison’s disease

Doctors usually recommend hormonal tests based on blood count results and biochemical tests that reveal sodium deficiency, low glucose, or excess potassium. Excess potassium can lead to abnormal ECG recording. The hormonal tests include: morning cortisol measurement in the blood and the 17-OHKS test from the XNUMX-hour urine collection. If both test results are lowered – we are dealing with adrenal insufficiency.

W niedoczynności kory nadnerczy oznacza się ACHT (rano). Jeżeli parametry są podwyższone, możemy być prawie pewni, że jest to choroba Addisona. Oprócz ACHT lekarze zalecają oznaczenia stężenia DHEA-S oraz androstendionu i aldosteronu, które w chorobie Addisona są obniżone.

Aby potwierdzić przyczynę autoimmunologiczną, wykonuje się badania immunologiczne na przeciwciała skierowane przeciwko 21-hydroksylazie.

In addition, doctors recommend computed tomography and ultrasound of the abdomen, which are useful in determining where the disease process is in the adrenal glands. The doctor responsible for controlling the course of the disease, as well as diagnosing it, is an endocrinologist who specializes in this topic.

Addison’s Disease – Treatment

Treatment of Addison’s disease is based on the supply of hormones to the body that the adrenal glands are unable to produce on their own. This simulation should follow the natural rhythm of hormone production during the day. It also aims to alleviate symptoms, equalize pressure and improve the patient’s well-being, thanks to the correction of electrolyte disturbances. There are 3 types of hormone substitutes that are produced by the cortex of the adrenal glands, the substitute:

1. androgens (is todehydroepiandrosterone),
2. cortisol (hydrocortisone is administered in doses that depend on the patient’s weight and height. The highest dose should be taken in the morning! The dose of the drug should be adequately increased in stressful situations and when our physical effort is very high),
3. aldosterone (this is fludrocortisone).

In addition to increasing the dose of hydrocortisone in Addison’s disease, you should also drink plenty of fluids, partially increase the amount of salt in your diet. It is important that patients always carry a wristband or bracelet with information about their disease and drug doses.

Addison’s disease, treated with appropriate measures, does not affect the patient’s life expectancy. It is only when we ignore the disease that we may be at risk of dying from adrenal crisis, which is characterized by a sudden worsening and aggravation of the symptoms of the disease. The conclusion is simple: prompt diagnosis and appropriate treatment are important.

Uwaga: jeśli chodzi o tuberculous origintreatment for Addison’s disease depends on the treatment of tuberculosis. In contrast, the treatment of the neoplastic process depends on chemotherapy.

Does Addison’s Disease Affect Fertility?

Addison’s disease does not usually reduce a woman’s ability to become pregnant. Yes, fertility may be reduced, but if the disease affects other organs in addition to the adrenal glands (e.g. when it occurs together with hypothyroidism). When it comes to pregnant women suffering from Addison’s disease – the doctor usually orders a change in the dosage of the preparations (women should remember to go to the endocrinologist immediately after diagnosis of pregnancy). Breastfeeding women should not take high doses of hydrocortisone, and if they do, they should not breastfeed.

After birth, your baby should be monitored closely as there is a risk of adrenal insufficiency.

Odżywianie w chrobie Addisona

Nutrition in Addison’s disease does not carry any special restrictions and rules that must be absolutely followed. Usually, patients eat like any healthy person, but it is different when there are other conditions such as diabetes or celiac disease (then a diet is needed). Patients with Addison’s disease are very easily dehydrated. Patients who take high doses of hydrocortisone may have problems with weight, appear overweight, which is difficult to lose, so it is important to follow at least basic nutritional rules to be able to maintain a healthy weight. Patients should:

1. drink at least one and a half liters of water a day;
2. avoid potassium-containing drinks (e.g. tomato juice),
3. w czasie upałów spożywać większą ilość wody, to samo dotyczy choroby, której towarzyszy biegunka czy temperatura,
4. drink an additional glass of water for each glass of coffee, tea or alcohol.