Addision’s Disease

What is Addision’s Disease?

Addison’s disease is the chronic, ongoing destruction of the adrenal gland, maybe from tuberculosis or some other reason. It may include a variety of vague symptoms that gradually worsen with time. There may be vomiting (it may become very forceful), diarrhoea, feeling weak and fatigued, a weight loss, and an increased desire to eat salt. The symptoms do not abate, but gradually worsen, indicating there is some underlying disease.

Addison’s disease is relatively rare, occurring in about four persons per 100,000. It is characterised by general weakness, feeling off-colour, weight loss, skin pigmentation (brownish) and sometimes gastric symptoms. If untreated it gradually worsens, and may be interrupted by an adrenal crisis and death as already described unless emergency treatment is forthcoming. It is more common in women than men, and in about 70 per cent of cases the adrenal gland gradually withers up and ceases working. In many patients adrenal antibodies are present in the blood indicating that the body has built up a resistance against itself. This is part of the body’s auto-immune system, and an increasing number of disorders appear to be caused in a similar manner.

Addision’s Disease Causes

The condition is common following surgical removal of the adrenal glands which is the treatment for Cushing’s syndrome (where the adrenals overproduce). The operation is also undertaken in some cases to control spread of breast cancer, and the risk of under activity must be borne in mind.

Addision’s Disease Symptoms

Usually the onset of the disease is insidious, and once established it pursues a slow course. The first symptoms are usually feeling off-colour, tired, and experiencing a loss of weight. Sometimes cessations of menstrual periods or infertility are early complaints. Pigmentation is often the very first symptom, and may precede others by some years. This is usually brown, often seen on the mucous lining inside the mouth and gums. Frequently it is marked in the creases of the hands, elbows and knees and in old scars, or where belts and straps directly rub on the skin. It is caused by increased amounts of ACTH being produced by the anterior pituitary gland under the brain. Another hormone secreted by this organ, MSH (melanocyte-stimulating hormone), is increased, and this acts directly on the pigment cells of the skin, causing them to increase in activity and so darken. Lack of appetite, nausea, vague abdominal pains and diarrhoea may develop.

The symptoms due to a reduced blood sugar level are frequent (hypoglycaemia). Without treatment, the patient will inevitably become progressively weaker remaining in bed for greater periods of time from sheer exhaustion and may develop contractures of the limbs through underuse. Finally, the patient may develop an acute adrenal crisis that could cause death unless treated urgently. Diagnosis is often fairly straightforward. However, tests will be carried out showing the levels of cortisol arc below normal. Also, the other tests for hormonal activity are below normal. A key test is to administer a dose of ACTH and see if plasma or urinary cortisol is increased (that indicates activity of the adrenal cortex). In true Addison’s disease there is no increase, for the gland is dead. Sometimes adrenal antibodies are found in the blood, and this finding further strengthens the diagnosis. The key symptoms however are weakness and weight loss in a patient with pigmentation.

Addison’s Disease Side Effects

When cortisone or related drugs are given orally, there is usually a prompt and striking improvement. The dose depends on the patient’s age and occupation, for this may require greater or lesser amounts, depending on the probable stress situations that could occur. The patient must take an intelligent interest in the illness and understand that increased doses of cortisone are necessary during times of stress, such as if undercurrent infections occur (whether these be real or psychological), or if pregnancy occurs or surgery is required. However, many of these situations will be under proper medical care.

The nature of cortisone given will vary; it may be a combination aimed at preventing adverse side effects due to fluid and sodium anomalies. Overdose can produce side effects, and the patient must know how to recognise these. At all times the patient must carry a card setting out the nature of the disability and therapy in the event of some adverse situation arising. With modern treatment and correct medical supervision the prospects are good. Pigmentation fades, pregnancy may be undertaken without fear, and a normal life span may result.

As with all endocrine disorders, diagnosis and treatment are specialised procedures. There would be no place for doctors and home physicians if people were to try to diagnose and treat themselves. This is only inviting disaster. If any of the potentially serious symptoms mentioned are in evidence, immediate referral to a doctor or to a large hospital where endocrine clinics and full facilities for investigation and treatment are available is mandatory. These disorders are quite different from simple viral infections such as the common cold, which can often be successfully treated with home remedies. Apart from taking a sensible attitude and noting and reporting as outlined, home medical care has no place in endocrine disorders.