Addison’s Disease

Definition: Addison’s disease is due to a deficiency of hormones (especially cortisol and aldosterone )secreted from the adrenal glands. This is also known as Addison disease, primary adrenal insufficiency, hypoadrenalism, hyporcorticism.

Incidence in India is less than one million cases per year. Drugs are very helpful in this incurable chronic disease.

Addison’s disease is characterized by adrenal insufficiency, especially hyposecretion of glucocorticoids. The disease is named to honor Thomas Addison, an English physician and scientist who described this disease.

1.	Definition
2.	Incidence in India and worldwide.
3.	Symptoms
4.	Signs
5.	Causes
6.	Diagnosis
7.	Treatment

Types

Addison’s disease is broadly classified into two groups :

Primary Addisons’ disease and

Secondary Addisons disease

Primary Addison’s disease is classified into

Idiopathic -Autoimmune disease and common in developed countries.

Infections: Generalised viral (cytomegalovirus ), fungal and tuberculous infections.

Iatrogenic: due to drugs: (ketoconazole) disease infection.or surgical removal of the adrenal gland.

Hemorrhage in both adrenal glands

Metastasis in both the adrenal glands.

Secondary adrenal insufficiency may be due to

1. Diseases of the anterior pituitary gland, therefore ACTH secretion is reduced.
2. Diseases of the hypothalamus that cause reduction of Corticiotrophic hormones (CTH).

Symptoms and signs:

1.Anorexia,nausea,vomiting,abdominal pain.

2. Weakness, lethargy. fainting attacks.

Hyperpigmentation of skin is usually more on skin exposed to sun rays, pressure points, and over the scars.

Hypoglycemia,hyponatremia,hypotension.

In stress conditions, a person suffering from Addison’s disease may develop acute Hypoglycemia and hypotension, known as Addison’s crisis. Addison’s crisis is a medical emergency, and if not treated promptly, it may cause death.

Diagnosis :

1. Physical examination -dark patches on the skin.
2. Serum electrolytes such as sodium,potassium levels.
3. Hormone estimation of cortisol,ACTH level.
4. X-rays -calcium deosits in the adrenal gland
5. ACTH stimulation test
6. CT scan

Treatment :

Hormone replacement therapy

In emergency vital sign supports are essential to support life.