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Addison's Disease



Addison's disease is characterized by insufficient production of the steroid hormones cortisol and aldosterone in the outer layers of the adrenal glands. Also known as primary adrenal insufficiency, classic symptoms include fatigue, gastrointestinal issues, changes in skin pigmentation, and potential behavior and mood changes. Addison's disease can progress slowly or rapidly, leading to acute adrenal failure. It is often caused by the immune system mistakenly attacking the adrenal glands. The disorder affects both genders equally and is seen in around 1 in 100,000 in the United States. Addison's disease may develop at any age but typically affects individuals between 30-50 years old.


Symptoms vary among individuals, and diagnosis can be challenging due to the nonspecific nature of early signs. Fatigue and hyperpigmentation are common initial symptoms. Gastrointestinal symptoms, muscle weakness, and dehydration may occur, along with low blood pressure. Addison's disease can affect emotions, causing irritability, depression, and poor concentration. Some individuals may crave salt, experience low blood sugar, and face menstrual irregularities.


In certain cases, symptoms may appear suddenly, triggering a life-threatening Addisonian crisis, a medical emergency with severe complications. The primary cause of Addison's disease is autoimmune reactions, but it can also result from tuberculosis, infections, cancer spread, hemorrhaging, or fatty substance accumulation in the adrenal glands.


Similar symptoms are seen in disorders like ACTH deficiency, congenital adrenal hyperplasia, and adrenoleukodystrophy. Diagnosing Addison's disease involves clinical evaluation, patient history, and specialized tests like the ACTH stimulation test and insulin-induced hypoglycemia test.


Current treatment focuses on addressing individual symptoms by replacing deficient hormones (hydrocortisone and fludrocortisone). Salt intake is encouraged, and affected individuals should carry identification indicating their condition. Some may undergo androgen replacement therapy for mood improvement and other benefits.


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References/Learn More!


Anglin RE, Rosebush PI, Mazurek MF. The neurophsychiatric profile of Addison’s disease: revisiting a forgotten phenomenon. J Neuropsychiatric Clin Neurosci. 2006;18:450-459.


Betterle C, Dalpra C, Greggio N, et al. Autoimmunity in isolated Addison’s disease and in polyglandular autoimmune diseases type 1, 2 and 4. Ann Endocrinol (Paris). 2001;62:192-201.


Erickson QL, Faleski EJ, Koops MK, et al. Addison’s disease: the potentially life-threatening tan. Cutis. 2000;66:72-74.


Griffing GT, Odeke S, Nagelberg SB. Addison Disease. Medscape. http://emedicine.medscape.com/article/116467-overview Updated: Mar 23, 2017. Accessed January 2, 2018.


Gurnell EM, Hunt PJ, Curran SE, et al. Long-term DHEA replacement in primary adrenal insufficiency: a randomized, controlled trial. J Clin Endocrinol Metab. 2008;93:400-409.


Kowal BF, Turco J, Nangia AK. Addison’s disease presenting as male infertility. Fertil Steril. 2006;85:1059:e1-4.


Mayo Clinic for Medical Education and Research. Addison’s disease. http://www.mayoclinic.com/health/addisons-disease/DS00361 Updated Aug. 04, 2017. Accessed January 2, 2018.


Ten S, New M, Maclaren N. Clinical review 130: Addison’s disease. J Clin Endocrinol Metab. 2001;86:2909-2922.





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