Disease, Illness and Condition Library
Addison's Disease
- In Addison's disease, the adrenal glands are underactive,
resulting in a deficiency of all adrenal hormones.
The body has two adrenal glands, one near the top of each kidney.
The inner part (medulla) of the adrenal glands secretes hormones, such
as adrenaline (epinephrine), that help control blood pressure, heart rate,
sweating, and other activities regulated by the sympathetic nervous system.
The outer part (cortex) secretes different hormones, including corticosteroids
(cortisone like hormones, such as cortisol) and mineralocorticoids (particularly
aldosterone, which controls blood pressure and the levels of salt and potassium
in the body). The adrenal glands also play a role in stimulating the production
of androgens (testosterone and similar hormones).
The adrenal glands are controlled in part by the brain. The hypothalamus, a
small gland in the brain involved in hormonal regulation, produces corticotropin
releasing hormones and vasopressin. These two hormones trigger the pituitary
gland to secrete corticotrophin (also known as adrenocorticotropic hormone or
ACTH), which stimulates the adrenal glands to produce corticosteroids.
The rennin-angiotensin-aldosterone system, regulated mostly by the kidneys,
causes the adrenal glands to produce more or less aldosterone.
The body controls the levels of corticosteroids according to need. The levels
tend to be much higher in the early morning than later in the day. When the
body is stressed, from illness or otherwise, the levels of corticosteroids
increase dramatically.
Addison’s Overview
Addison’s disease can start at any age and affects both men and women
equally. In 70% of people with Addison’s disease, the cause is not precisely
known, but the adrenal glands are affected by an autoimmune reaction in
which the body’s immune system attacks and destroys the adrenal cortex.
In the other 30%, the adrenal glands are destroyed by cancer, an infection
such as tuberculosis, or another identifiable disease. In infants and children,
Addison’s disease may be due to a genetic abnormality of the adrenal glands.
Secondary adrenal insufficiency is a term given to a disorder that is similar
to Addison’s disease. In this disorder, the adrenal glands are underactive
because the pituitary gland is not stimulating them, not because the adrenal
glands have been destroyed or have otherwise directly failed.
When the adrenal glands become underactive, they tend to produce
inadequate amounts of all of the adrenal hormones. Consequently, Addison’s
disease affects the balance of water sodium, and potassium in the body, as
well as the body’s ability to control blood pressure and react to stress.
In addition, loss of androgens, such as dehydroepiandrosterone (DHEA),
is thought to be responsible for the loss of body hair in women. In men,
testosterone from the testes more than makes up for this loss. DHEA
has additional effects that do not relate to androgens.
When the adrenal glands are destroyed by infection or cancer, the adrenal
medulla and thus the source of epinephrine is lost. However, this loss does
not cause symptoms.
A deficiency of aldosterone in particular causes the body to excrete large
amounts of sodium and retain potassium, leading to low levels of sodium and
high levels of potassium in the blood. The kidneys are not able to concentrate
urine, so when a person with Addison’s disease drinks too much water or loses
too much sodium, the level of sodium in the blood falls. Failure to concentrate
urine ultimately causes the person to urinate excessively and become
dehydrated. Severe dehydration and a low sodium level reduce blood
volume and can culminate in shock.
Corticosteroid deficiency leads to an extreme sensitivity to insulin so that the
level of sugar in the blood may fall dangerously low. The deficiency prevents
the body from manufacturing carbohydrates from protein, fighting infections,
and healing wounds very well. Muscles weaken, and even the heart can
become weak and unable to pump blood adequately. In addition a person’s
blood pressure may become dangerously low.
People with Addison’s disease are not able to produce additional
corticosteroids when they are stressed. This makes them susceptible
to serious symptoms and complications when confronted with illness,
extreme fatigue, severe injury, surgery, or, possibly, severe
psychological stress.
In Addison’s disease, the pituitary gland produces more corticotrophin in
an attempt to stimulate the adrenal glands. Corticotrophin also stimulates
melanin production, so dark pigmentation of the skin and the lining of the
mouth often develop.
Symptoms
When a person first develops Addison’s disease they feel tired, weak, and
dizzy when standing up after sitting or lying down. These problems may
develop gradually and insidiously. People with Addison’s disease develop
patches of dark skin; this darkness may seem like tanning, but it appears
on areas that have not been exposed to the sun. Even people with dark
skin can develop excessive pigmentation, although the change may be
slightly more difficult to recognize. Black freckles may develop over the
forehead, face, and shoulders; a bluish black discoloration may develop
around the nipples, lips, mouth, rectum, scrotum, or vagina.
Most people lose weight, become dehydrated, have no appetite, and develop
muscle aches, nausea, vomiting, and diarrhea. Many become unable to tolerate
cold. Unless the disease is severe, symptoms tend to become apparent only
during times of stress. Periods of hypoglycemia, with nervousness and extreme
hunger, can occur, particularly in children.
If Addison’s disease is not treated, severe abdominal pains, noticeable
weakness, extremely low blood pressure, kidney failure, and shock may occur
(adrenal crisis). An adrenal crisis often occurs if the body is subjected to stress,
such as an accident, injury, surgery, or severe infection. Death may quickly
follow.
Addison’s disease can become present when the adrenal cortex
is seriously under active.
- Symptoms:
* Excessive pigmentation
* Black freckles over the forehead, face, and shoulders
* Bluish discoloration around the lips, mouth, nipples,
rectum, scrotum, and vagina
* Depression
* Moodiness
* Problems dealing with stress
* Fatigue
* Low blood pressure
* Dizziness
* Appetite loss
* Diarrhea
* Nausea
* Salty food cravings
* Constantly feeling cold
Discoloration and darkening of the skin is common in those with Addison’s;
discoloration of the elbows, knees, skin folds, scars, and creases in the
palms become more noticeable when exposed to the sun. This disease
is also characterized by the development of bands of pigment running
the length of the nails and darkening of the hair.
The most common type of Addison’s is autoimmune Addison’s disease.
This happens when the body’s own immune system turns against itself
and starts attacking tissue of the adrenal glands, destroying them. It may
be associated with other autoimmune disease that affects other endocrine
glands. The most common of these is hypothyroidism or under active thyroid.
Addison’s disease that coexists with hypothyroidism is known as Schmidt’s
syndrome. Less commonly Addison’s occurs together with insulin dependent
diabetes mellitus, another autoimmune disease, or insufficiencies of the
parathyroid glands and/or gonads, or with pernicious anemia.
The bad news is Addison’s disease is a chronic condition that probably will
require lifelong treatment. The good new is this disease should not affect
your life expectancy if treated correctly.
Diagnosis
Because the symptoms may be start gradually and be mild, and because no
single laboratory test can positively confirm early stage Addison’s disease,
doctor’s usually do not suspect it at first. Sometimes a major stress makes
the symptoms more obvious and precipitates a crisis.
Blood tests may show low sodium and high potassium levels and usually
indicate that the kidneys are not working well. A doctor who suspects Addison’s
disease measures cortisol levels, which may be low, and corticotrophin levels,
which may be high. However, a doctor usually confirms the diagnosis by
measuring cortisol levels after they have been stimulated with corticotrophin.
If cortisol levels are low, further tests are needed to determine if the problem
is Addison’s disease or secondary adrenal insufficiency.
Conventional Treatment
Regardless of the cause, Addison’s disease can be life threatening and must be
treated with corticosterois. Usually treatment can be started with hydrocortisone
or prednisone (a synthetic corticosteroid) taken by mouth. However, people who
are severely ill may be given cortisol intravenously or intramuscularly at first and
then hydrocortisone tablets.
Because the body normally produces most of its cortisol in the morning,
replacement hydrocortisone should also be taken in divided doses, with the
larges dose in the morning. Hydrocortisone will need to be taken every day for
the rest of the person’s life. Larger doses of hydrocortisone may be needed
when the body is stressed, especially from an illness, and may need to be
given by injection f the person has severe diarrhea or vomiting.
Most people also need to take fludrocortisones tablets every day to help
restore the body’s normal excretion of sodium and potassium. Supplemental
testosterone is not usually needed, although there is some evidence that
replacement with DHEA improves the quality of life. Although treatment
must be continued for life, the outlook is excellent.
Suppression of Adrenal Function by Corticosteroids
In people who take large doses of corticosteroids, such as prednisone, the
function of the adrenal glands can become suppressed. The suppression
occurs because large doses of corticosteroids prevent the hypothalamus
and pituitary glands from producing the hormones that normally stimulate
adrenal function. If the person suddenly stops taking corticosteroids, the
body cannot restore adrenal function quickly enough, and temporary
adrenal insufficiency (a condition similar to Addison’s disease) results.
Also, when stress occurs, the body is not able to stimulate the additional
production of corticosteroids that are needed.
Therefore, doctors never discontinue the use of corticosteroids suddenly if
they have been taken for more than 2 or 3 weeks. Instead, they gradually
reduce the dosage over weeks and sometimes months. Also, the dose may
need to be increased in people who become ill or otherwise severely stressed
while taking corticosteroids. Corticosteroid use may need to be resumed in a
person who becomes ill or otherwise severely stressed within weeks of having
the corticosteroid tapered and discontinued.
Natural Remedies
Other treatments for Addison's disease include natural and holistic remedies
which can be effective in assisting with the relief of symptoms as well as
addressing the individual’s overall health and well being.
Herbal and homeopathic remedies are gentle, yet effective - without the
harmful side effects of conventional medicine. A combination of herbs
such as Borago officinalis (Borage), Eleutherococcus senticosis (Siberian
Ginseng) and Astragalus membranaceous (Huang Qi) supports the functioning
of the adrenal glands and helps to assist the body to fight the stress of modern
day living.
Ginger (which stimulates digestion and acts as an anti-nausea aid to treat
symptoms of nausea and vomiting) can be beneficial in lessening the symptoms
of Addison’s disease. Siberian ginger is particularly effective as a general tonic
and helps to relieve physical and emotional stress, while liquorice enhances
the activity of mineralocorticoids. Consult a homeopath or herbalist about
remedies for your symptoms.
Complimentary or Alternative Care Options
* Meditation
* Yoga
* Tai Chi
* Acupuncture
Suggestion for Coping with Addison’s Disease from Native Remedies
People suffering from Addison’s disease can live a productive life but there
are certain measures that can be taken to ensure that they cope better.
These preventative measures include:
* Administer medication daily according to the dosage and directions
* Carry a medical identification card or bracelet which will be able to inform
medical personnel of your condition and the type of treatment you may need
should you be involved in an accident or become acutely ill.
* Treat minor illnesses with extra salt and fluid
* If you experience fever, vomiting and diarrhea, you need to seek emergency
treatment - intravenous saline and hydrocortisone is commonly administered
* Increase the intake of salt in your diet
* Monitor your weight regularly if you have been vomiting frequently and your
appetite has been poor
* Monitor your blood pressure regularly because high blood pressure may
indicate that your medication needs to be adjusted. If you are feeling
lightheaded, your blood pressure may be low
* Maintain an open, honest relationship with your doctor where you can freely
discuss your symptoms and learn to adjust your medication dosage during
times of stress
* Join a support group where you can gain information and support from others
who have the same condition
- Sources: Smart Living for Better Health
Merck Manual of Medical Information
Native Remedies
Helpful Herbal Supplements
AdrenoBoost - Natural remedy to support normal cortisol hormone levels,
balance of adrenal hormone levels, and promote healthy adenal gland function
Continue
Immunity Plus - For full immune system support for adults and teens - Continue
AnemiCare - Homeopathic remedy temporarily increases iron absorption
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