Chủ Nhật, 12 tháng 1, 2014

Addisons Disease

Addisons Disease When the adrenal glands of the body do not produce sufficient amount of hormone called cortisol/aldosterone it causes Addison’s disease. This manifests in the form of loss of weight, muscular weakness, tiredness and low blood pressure. This disease is otherwise known as hypocortisolism. It can occur in both sexes and on any individual. The symptoms can be fully controlled by effective replacement of hormone therapy.

Symptoms :

Addison’s disease progresses slowly and for some people it may take months or even years to show its symptoms. Some of the signs of this disease include skin darkening, weight loss, loss of appetite, fatigue, low blood sugar and low blood pressure. Some people may even faint suddenly due to reduced blood pressure. It can also cause irritability, nausea, joint pain and depression. In women there can be loss of body hair and sexual dysfunction due to suppression of hormone.

In rare cases, the symptoms would appear suddenly causing severe vomiting, abdominal pain and loss of consciousness. It would also reduce the salt content in the body and this condition is called acute adrenal failure. If you have fatigue, nausea, vomiting, dizziness and craving for salt then you need to consult doctor immediately.

Causes :

Addison’s disease is caused by improper functioning of adrenal glands. These glands are found above your kidneys and are responsible for producing aldosterone and cortisol hormone. This gland is part of endocrine system and controls every organ and tissues in your body.

Corticosteroids are secreted by the outer layer of the gland called cortex and adrenaline hormone is secreted by interior layer called medulla. The cortex region also produces gluco-corticoids (responsible for converting the food substances into energy), mineralocorticoids (aldosterone which controls the sodium and potassium levels in your body thus maintaining the blood pressure) and androgens (male sex hormone). Androgen hormone is responsible for sex drive and builds up muscle mass in the body for both men and women.

Any imbalance in the production of these hormones will have serious effect on the immune system. Addison’s disease is a kind of autoimmune disorder which means the body’s own immune system will attack and destroy healthy cells/tissues of the cortex. Primary adrenal insufficiency and secondary adrenal insufficiency can also cause this problem. When the pituitary gland is tampered (due to some reason) it may not produce enough amounts of ACTH (adrenocorticotropic hormone) which in turn slows down the production of adrenal hormone causing Addison’s disease. This process is termed as secondary adrenal insufficiency.

Addison’s disease occurs rarely (1 out of million) and very often this disease is caused due to autoimmune disorder. Polyendocrine deficiency syndrome can also cause failure of adrenal gland called Type 1 problem which is seen in children due to underactive thyroid glands, anemia and chronic hepatitis. Type 2 problem occurs in young adults leading to diabetes, slow sexual development, loss of pigment on the skin. In rare cases tuberculosis can also attack the adrenal glands causing Addison’s disease. Patients who are taking corticosteroids for long time can get this problem when they stop taking the drug suddenly.

Role of Cortisol and Aldosterone :

Cortisol hormone is classified under the category of glucocorticoids. It assists in maintaining the blood pressure of the body, and helps in balancing the insulin level and regulates the protein and carbohydrate metabolism. Aldosterone helps in maintaining blood pressure and regulates the salt and water content in the body. Any discrepancy in its level will cause imbalance in potassium and sodium level causing renal failure.

Diagnoses :

Your doctor will collect complete medical history and order for blood test for checking the levels of sodium and potassium. The same blood profile will also give information about the count of antibodies related to immune system. He may request for ACTH stimulation test and CRH stimulation test for checking the level of cortisol in blood. In rare cases he may conduct insulin induced hypoglycemia test if he suspects secondary adrenal insufficiency. If needed, he may conduct CT scan of the abdomen to rule out any abnormalities.

Treatment :

Any method of treatment given is to regularize the level of hormone in the body. Depending on the health condition of the patient, he may prescribe oral corticosteroids like fludrocortisones or Cortef. For some cases, he may inject corticosteroid directly if the patient does not tolerate oral drugs. Androgen replacement therapy is recommended for treating its deficiency. Drugs like dehydropiandrosterone are given for women with androgen deficiency for inducing libido and increasing sense of well-being.

To compensate loss of sodium and potassium ions in blood sufficient amounts are given orally. The dosage of sodium is required more than regular dose while doing heavy strenuous work and in stressful situations. For people with Addisonian crisis immediate medical care is to be given by injecting hydrocortisone intravenously. The patient will be put on IV fluids like saline solution or dextrose for compensating the blood sugar loss and to boost up blood pressure. In case of chronic problem surgery is to be done.

Coping Techniques :

In case your loved ones or relative have Addison’s disease it is suggested to carry a medical card so that others would render immediate help. Always ensure that you are keeping extra dose of medication with you in case you have lost it or missed one dosage. Taking corticosteroid injection with you will help you in case you feel like collapsing.

For pregnant women diagnosed with adrenal insufficiency instead of oral pills hormone injection would be the best option to control nausea/vomiting. After delivery, the dosage is reduced under close supervision and replaced by oral pills gradually.

Prevention :

It is not possible to prevent Addison’s disease, but you can take precautions to reduce stressful situations. You can always limit the risk factors of getting infections, watch your blood sugar level closely and identify any new symptoms.

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