$Unique_ID{BRK02146} $Pretitle{} $Title{Addison's Disease} $Subject{Addison Addison's Disease fatigue weakness chronic progressive Adrenocortical Insufficiency autoimmune adrenal glands tuberculosis tumor amyloidosis inflammatory necrosis cortex weight loss anemia low blood pressure hypoglycemia sex abdominal pains diarrhea indigestion nausea vomiting darkening skin pigmentation acute hydrocortisone saline hormones circulating cortisone fludrocortisone steroids } $Volume{} $Log{ Location and Function of the Endocrine Glands*0002901.scf The Adrenal Glands*0002906.scf} Copyright (c) 1993 Tribune Media Services, Inc. Addison's Disease ------------------------------------------------------------------------------ QUESTION: At first we just attributed the increasing fatigue and weakness in my husband to the stress of losing his job and getting a new one. But when rest and food didn't get him back on his feet, though funds were low, we visited the doctor. The diagnosis is Addison's Disease, and we are dismayed by the news that this is a chronic and progressive disease. Can you please address this subject in your column, and tells us the straight truth? Thank you. ------------------------------------------------------------------------------ ANSWER: Dr. Thomas Addison first described this disease in 1849, in a article entitled "Diseases of the suprarenal capsule" which appeared in the London Medical Gazette. We have since come to know this disease as Chronic Adrenocortical Insufficiency and believe it to be the result of an autoimmune process (in about 70 percent of the cases) which slowly destroys the outer layer (cortex) of the adrenal glands. In the rest of the cases the destruction may be caused by tuberculosis, tumor growth, amyloidosis, or inflammatory necrosis. It may strike at any age, affects women and men equally, and frequently is noticed for the first time after a period of stress of trauma. The adrenal cortex is formed of a layer of cells that occupy the outer layers of the two adrenal glands which perch on the kidneys. These tissues produce several important steroid hormones, and it is the lack of these hormones in sufficient quantities that lead to the symptoms. In addition to the fatigue and weariness you mention, patients with Addison's disease also show weight loss, anemia, low blood pressure and lower quantities of sugar in their blood (hypoglycemia), decreased interest in sex, and abdominal pains accompanied by diarrhea, indigestion, nausea and vomiting. There is a gradual darkening of the skin caused by increased pigmentation, and this is often the first clue to the disease's presence. When the disease strikes suddenly, acute adrenal insufficiency, the patient must be hospitalized. Intravenous therapy containing hydrocortisone and saline solution can restore the blood pressure to normal, and provide the amount of fluids the circulatory system requires. Once the patient is stabilized, other examinations and testing can be started. The diagnosis is made by a number of laboratory tests that search for the levels of circulating hormones in the blood, or the lack of response of the adrenal gland to certain tests that normally stimulate the action of the gland. The treatment of Addison's requires replacing the missing hormones, such as hydrocortisone and fludrocortisone. These essential steroids must be taken faithfully for the rest of your husband's life, and he must be carefully followed by the doctor. Since the body can no longer produce the quantity of hormones required, addition medication is prescribed during periods of stress. An operation, an infection and even a minor illness may require an upward adjustment to the daily medicine schedule, to prevent the low blood pressure that may result from insufficient hormone supplies in the body. I advise my patients with Addison's to obtain a medical identification bracelet that alerts physicians to their special condition in the case of emergency. The good news is that when the diagnosis is made early enough, and the medications are taken regularly as directed, a full and productive life can be achieved. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.