Addison's disease

A. Sandhya -

The human body has two small glands located on top of each kidney known as adrenal glands. Each adrenal gland is composed of two distinct parts. The outer part is called the adrenal cortex and the inner part is called the adrenal medulla. They produce chemical messengers called hormones to regulate various functions. The adrenal cortex produces steroid hormones, namely aldosterone, cortisol, and androgens.
These hormones help the body respond to stress, regulate the use of protein, carbohydrates, and fat, help maintain blood pressure and cardiovascular function,  control inflammation,  regulate the amount of salt and water in the body.
If adrenal glands fail to produce enough steroid hormones, it will lead to  long-term endocrine disorder known as  Addison's disease or primary adrenal insufficiency or hypocortisolism.
Addison's disease occurs in all age groups and both sexes, and can be life-threatening. Usually it occurs in individuals between 30-50 years of age.

Symptoms

Symptoms usually develop slowly, often over several months and the disease progresses so slowly that symptoms are ignored until an injury or illness occurs. Sometimes the symptoms of Addison's disease may appear suddenly making the symptoms severe and worse.
Addisonian crisis or Acute adrenal failure can lead to life-threatening shock and it requires emergency medical treatment.
Symptoms of Addison's disease are:

  • high fever
  • abdominal pain,
  • weakness,
  • weight loss
  • extreme fatigue
  • decreased appetite
  • sores in the mouth
  • hyperpigmentation -- darkening of the skin
  • low blood pressure causing lightheadedness or fainting
  • salt craving
  • hypoglycemia -- low blood sugar
  • nausea,
  • diarrhea or vomiting  leading to dehydration
  • confusion
  • pain in lower back or legs
  • sleep disturbances
  • reduced consciousness or delirium
  • visual and auditory hallucinations
  • muscle or joint pains
  • irritability
  • depression or other behavioral symptoms
  • body hair loss
  • sexual dysfunction in women
  • acute adrenal failure (Addisonian crisis)

Causes

Addison's disease is caused by damage to the adrenal glands,  which can result in under secretion of the adreno cortical hormones.
Nearly, 70% of Addison's disease may be caused due to autoimmune diseases like type 1 diabetes or Graves’ disease in which the immune system attacks the adrenal glands by mistake.
Other causes may be

  • adrenalectomy - the surgical removal of the adrenal glands
  • hemorrhage
  • prolonged administration of glucocorticoids such as prednisone,
  • chronic infections in the body like tuberculosis
  • cancer and tumors
  • certain blood thinners used to control clotting in the blood
  • traumatic brain injury
  • genetic defects in which the adrenal glands do not develop properly

Prevention

Addison's disease can't be prevented, but addisonian crisis can be avoided by seeking doctor for immediate medication when the symptoms like tiresome, weakness, or losing weight are observed.

Treatment

The treatment involves corticosteroid replacement therapy i.e. taking the cortical hormones  that are missing. The medications are to be taken for life long.
Generally, doctors advise patients to wear a medical alert bracelet or necklace that informs healthcare professionals that they have Addison's disease.
Medications are taken as directed and regular doctor consultations are required.

Side effects include sleep problems, acne, slow wound healing, dizziness, nausea, and increased sweating, changes in menstrual cycle, developing a deeper voice, and facial hair growth.

Food and Diet

The best diet for people with Addison's disease is a well balanced nutritious diet with three meals per day, adequate complex carbohydrate and protein, and adequate salt. This may include high-protein foods, vegetables and whole grains.
If hypoglycemia is frequent, a higher dose of hydrocortisone is required along with  small snacks between meals.
To maintain bone health, enough dietary calcium and vitamin D intake is needed .

foods to avoid

  • white sugar
  • white flour
  • alcohol
  • caffeine
  • soda
  • fried food
  • processed food
  • fast food
  • artificial sweeteners
    Regular, balanced meals and healthy snacks  can maintain cortisol levels all day.