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Chronic Adrenocortical Insufficiency

more about Chronic Adrenocortical Insufficiency

Addison's disease

  • Addison's Disease is caused by the destruction of the central part of the adrenal glands. This area makes the following hormones: Cortisol (which responds to stress and effects the immune system, inflammation, and blood sugar), aldosterone (regulates kidneys and blood pressure), and androgens (sex hormones though not their primary source).

  • Weakness
  • Fatigue
  • Lightheadedness
  • Faintness
  • Weight loss
  • Muscle aches
  • Joint aches
  • Loss of appetite
  • Nausea/vomiting
  • Anxiety/irritability
  • Emotional lability
  • Chronic Diarrhea
  • Salt craving
  • Depression

  • Autoimmune destruction is the most common cause -- i.e., the body's immune system mistakenly attacks the adrenal glands.
  • Tuberculosis bacterium may infect the gland (now a rare cause in the USA).
  • Hemorrhage (bleeding) into the adrenal glands generally occurs in patients on anticoagulants (blood thinners) during open-heart surgery and after trauma.
  • Many other disorders, such as Metastatic Cancer (lung, breast, kidney, or colon), side effects of drugs (e.g., Ketoconazole), radiation therapy, surgical removal of adrenals, Sarcoidosis, Amyloidosis, and infections (e.g., Histoplasmosis, meningococcemia, etc.) may very rarely cause Addison's Disease.

  • Findings that may present on examination:
    1. Low Blood Pressure
    2. Increased heart rate
    3. Dilated pupils
    4. Confusion or memory problems
    5. Tremors
    6. Mouth -- may have pigmented areas inside the cheeks
    7. Skin becomes darker (''appears tanned")
    8. Multiple new freckles
    9. Darkening of the skin of the elbows, knuckles, and knees.
    10. Darkening of the skin of the back of the neck, palm creases, and nail beds.
    11. Nipples and areolas (pigments areas of breast) become darker
    12. Vitiligo (areas of skin lose all color)
    13. Seizures
    14. Hallucinations
    15. Coma
  • Blood tests:
    1. White blood cell proportions in blood are altered
    2. Blood sugar is often low
    3. Sodium level is low
    4. Potassium level is high
    5. Calcium level may be high
    6. High levels of very long chain fatty acids (VLCFAs)
    7. Low morning plasma Cortisol
    8. ACTH level is elevated
    9. Cosyntropin stimulation test
    10. Anti-adrenal antibodies
  • Imaging Tests:
    1. Chest X-Ray to look for cancer, Tuberculosis, infection
    2. Abdominal X-Ray may show calcification (Calcium deposits) in the adrenals.
    3. CT scan of abdomen to evaluate the adrenal glands

  • Replacement therapy for hormones no longer being manufactured by the adrenal gland
  • Hydrocortisone or Prednisone
  • Fludocortisone acetate
  • Extra salt (NaCl) in diet
  • Appropriate amounts of Potassium and water in the diet.

  • Special considerations

- The dose of Hydrocortisone or Prednisone must be increased when the body is under stress, such as with an infection or around the time of surgery. This is very important and can be life threatening if not properly monitored by a physician.

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