Addison's Disease

Pathogenesis

It can be characterized by inadequate corticosteroid and mineralocorticoid synthesis and elevated levels of serum ACTH

Caused by autoimmune mechanisms that destroy adrenal cortical cells

Incidence/Prevalence

Approximately 1 in 100,000 people in United States have Addison’s disease. The overall prevalence is estimated to be between 40 and 60 people per million of the general population

The incidence is 0.6/100,000 of the population per year

The total number of people affected by this condition at a given time 4 to 11/100,000 of the population

Risk Factors

Swelling (inflammation) of the thyroid gland that often results in reduced thyroid function

Thyroid gland produces too much thyroid hormone

Itchy rash with bumps and blisters

Parathyroid glands in the neck do not produce enough parathyroid hormone

Pituitary gland does not produce normal amounts of some or all of its hormones

Autoimmune disorder that affects the nerves and the muscles they control

Body does not have enough healthy red blood cells

Testicles cannot produce sperm or male hormones

Type I diabetes

Loss of brown color (pigment) from areas of the skin

Diagnostics

Blood test: Measures your blood levels of sodium, potassium, cortisol and adrenocorticotropic hormone (ACTH), which stimulates the adrenal cortex to produce its hormones

ACTH stimulation test: This test measures the level of cortisol in your blood before and after an injection of synthetic ACTH

Insulin-induced hypoglycemia test: The test involves checking your blood sugar (blood glucose) and cortisol levels after an injection of insulin

Imaging tests: Computerized tomography (CT) scan of your abdomen to check the size of your adrenal glands and look for other abnormalities

Treatments

All treatment for Addison's disease involves medication

Hydrocortisone (Cortef), prednisone or methylprednisolone to replace cortisol

Fludrocortisone acetate to replace aldosterone

You will need to get plenty of salt (sodium) in your diet

Clinical Manifestations

Extreme fatigue

Weight loss and decreased appetite

Darkening of your skin (hyperpigmentation)

Low blood pressure, even fainting

Salt craving

Low blood sugar (hypoglycemia)

Nausea, diarrhea or vomiting (gastrointestinal symptoms)

Abdominal pain

Muscle or joint pains

Irritability

Depression or other behavioral symptoms

Body hair loss or sexual dysfunction in women

Women are more likely than men to develop Addison’s disease.

This condition occurs most often in people between the ages of 30 and 50

Sources

Huether, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding pathophysiology. St. Louis, MO: Elsevier.

Addison’s Disease. (2018, January 17). Retrieved September 30, 2020, from https://rarediseases.org/rare-diseases/addisons-disease/

Munir, S., & Waseem, M. (2020, July 05). Addison Disease. Retrieved September 30, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK441994/

Addison disease: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved September 30, 2020, from https://medlineplus.gov/ency/article/000378.htm

Mayo Clinic. (2019, October 09). Addison's disease. Retrieved October 13, 2020, from https://www.mayoclinic.org/diseases-conditions/addisons-disease/diagnosis-treatment/drc-20350296