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CD-ROM Today (UK) (Spanish) 15
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02146.txt
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1994-01-17
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$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
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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.
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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.