Addison's disease

 

Addison's disease is a primary insufficiency, which is rare. It is common between 30 years and 50 years of age and affects both sexes equally. It is caused when there is destruction of >90% of adrenal gland. 

 

 

Addison's disease is caused due to the lack of secretion of glucocorticoids and mineralocorticoids from the adrenal gland which is located in the abdomen above the kidney. Common causes include:

a) Autoimmune diseases

b) Infections such as tuberculosis (commonest), opportunistic infection in HIV [cytomegalovirus (CMV), mycobacterium avium)

c) Primary or metastatic neoplasty

d) Trauma

e) Metabolic disturbance such as amyloidosis

f) Drugs such as ketoconazole and megestrol

 

 

Common symptoms include:

1. General debility

2. Feebleness of the heart's action

3. Irritability of the stomach

4. Peculiar change in the color of the skin

5. Asthenia

6. Hyperpigmentation (due to excess of melatonin)

7. Mood disturbances include emotional liability, low self-esteem, loss of concentration, irritability, and depression to frank psychosis.

8. Gastrointestinal tract disturbances which includes, 

a) Anorexia

b) Weight loss

c) Nausea

d) Vomiting

e) Diarrhea

f) Abdominal pain

9. Hypotension (BP <100/70)

 

 

Diagnosis of Addison’s disease remains a clinical dilemma as the signs are non-specific. Common tests include:

1. Short adrenocorticotropic hormone (ACTH) stimulation test

2. Other tests include,

a) Measurement of serum electrolytes (hyponatremia and hyperkalemia)

b) To rule out infectious or autoimmune cause

 

 

Treatments include:

1. Specific hormone replacement

2. Mineralocorticoid replacement is achieved with fludrocortisones along with ample amounts of salt in diet (3 to 4 g/day).