Adrenal Insufficiency (Addison’s disease): Causes, Symptoms

Adrenal insufficiency or Addison’s disease is a disorder/problem of the adrenal gland that occurs when the gland fails to produce enough secretions of hormones. When this happens, we say that the Adrenal gland is Insufficient.

You might wonder what the Adrenal gland is. Well, the adrenal gland is an organ of the body that produces substances known as hormones. These hormones produced by the adrenal gland helps the body control the amount of salt, urine produced, as well as sex hormones (in the male). Basically, this gland produces the body’s own steroids. Medically these hormones are the mineralocorticoids, glucocorticoids and/or adrenal androgens.

Most persons with this disorder/problem would not even know they have the condition, until when the person undergoes serious stress, example, in the form of trauma as in accident or surgery, infection, etc. In fact, you only notice symptoms of this disease when about 90% of the gland has already been damaged.

Why is Adrenal Insufficiency Called Addison’s Disease?

The disease was best explained in the year 1849 by a doctor known as Dr. Thomas Addison, where he pointed out the nature & causes of the disease, and after that, the disease was named after him as Addison’s disease. Just the way you have Ebola or Lassa Fever named after the places where they were first identified.

This disease affects people in all ages and also affects both males and females.

Cause of Adrenal Insufficiency (Addison’s Disease)

The Causes of Addison’s disease could be primary or secondary. That is if the problem causing the decrease in production (insufficiency) is directly from the gland itself (primary) or if it is from other places outside the gland, like in the brain (secondary).

Primary chronic adrenal insufficiency

Autoimmune: The most common reason for the development of Addison’s disease is what we call Auto-immune destruction of the gland. What this means is that our body’s immune system (soldiers of the body that are there to fight against external infections) by itself starts fighting the adrenal gland, thereby destroying it.

Other causes of this condition results from destruction of the gland by diseases like tuberculosis, tumors, hemorrhage (bleeding), or death due to swelling.

Medication: Adrenal insufficiency can also be as a result of medications or drugs that you take by yourself. This is more commonly observed in those that self-prescribe or abuse drugs. Example of these drugs are those that block steroids synthesis (eg, drugs like ketoconazole (common antifungal), etomidate (anaesthesia), rifampicin (used in treatment of Tuberculosis)). Others are mifepristone, metyrapone, etc.

CAH: In children, one of the most common causes is what we call Congenital Adrenal Hyperplasia (CAH). This condition can make a girl to look like a boy (including the genitals). We would talk about this condition some other time.

Secondary adrenal insufficiency

In this cases, the problems causing the Adrenal Insufficiency is not from the adrenal gland but from areas in the brain (such as the pituitary gland or the hypothalamus). Secondary adrenal insufficiency can be seen in conditions that affects or destroys the Pituitary gland or affects corticosteroid production.

Symptoms of Adrenal Insufficiency (Addison’s Disease)

As explained earlier, most persons with Addison’s disease may not show any symptoms of the condition, and mostly only manifest during stress or illness.

The early symptoms of Addison’s disease are: weakness, tiredness and low blood pressure (known as hypotension).

Others are loss of appetite, weight loss, nausea, vomiting, abdominal pain, or diarrhea or constipation. People with Addison disease also develop darkened pigmentation of their skin, even the areas that are not exposed to sunlight.

Addison's disease
Skin Changes observed in Addison Disease. Image Credit: MSD Manuals

You may also notice a reduction in the hairs around your armpit or genital regions, while some women may have missed periods or absence of menstruation.

Treatment of Addison’s Disease

Individuals with this condition or those who notice any of the symptoms above are advised to see a doctor. Your doctor would examine you and also request you to do some laboratory investigations that would help him better understand your problems and also guide you on the best management option for you.

Management options include drugs and medications such as Hydrocortisone or prednisone, the dose and duration of which would be decided by your doctor, depending on the state of your condition.

Addison’s crisis

A form of Adrenal Insufficiency seen in individuals with chronic primary Addison’s disease, due to deranged aldosterone level (a hormone that controls the salt and water removal process from the body). The precipitating factor are infections, excessive sweating, trauma, surgery.

Symptoms seen here are those of hypotension and shock. Others are profound weakness, low sugar, severe pain in the abdomen.

Prevention of Adrenal Insufficiency (Addison’s Crisis)

  • Patient and family education is the most important factor in the prevention, it’s done to enlighten them on the reason for a life-long replacement therapy.
  • Emergency precautions such as wearing of medical alert bracelet or necklace and carrying of emergency medical information card that provides information on the diagnosis, medications, daily doses and the physician involved in the management.
  • Also patient should have supplies of prescribed medications and be educated on how and when to administer it
  • Patients and family should be taught on how to use the self-injection kits in case there’s exacerbation of their conditions, especially in hot climates.
  • Parents should be advised to provide patient with fluids containing salt and sugar during illness such as sports drinks etc.

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