ADDISON'S DISEASE The cause of Addison's disease is a
deficiency of the adrenocortical hormones cortisql,
aldosterone and androgens due
to destruction of the adrenal cortex. It occurs in about 1:25,000 of the
population. Although the destruction of the adrenal cortex in
Symptoms The clinical symptoms appear slowly and depend on the severity of the underlying disease process. The patient usually complains of anorexia, nausea, weakness, tiredness and loss of weight. The skin becomes pigmentated due to the increased production of acth. Faint-ness, especially on standing, is due to postural hypotension secondary to aldosterone deficiency. Women lose their axillary hair and both sexes are liable to develop mental symptoms such as depression. Acute episodes -Addisonian crises - may occur, brought on by infection, injury or other stressful events; they are caused by a fall in aldosterone levels, leading to abnormal loss of sodium and water via the kidneys, dehydration, low blood pressure and confusion. Patients may develop increased tanning of the skin from extra pigmentation, with black or blue discoloration of the skin, lips, mouth, rectum and vagina occurring, anorexia, nausea and vomiting are common and the sufferer may feel cold.
Diagnosis depends on demonstrating impaired serum levels of Cortisol and inability of these levels to rise after an injection of ACTH.
Treatment consists in replacement of the deficient hormones - hydrocortisone is commonly used - and this enables patients to lead a completely normal life and to enjoy a normal life expectancy. Treatment of any complicating infections such as tuberculosis is essential. Sometimes diabetes mellitus coexists with Addison's disease and must be treated.
Secondary adrenal insufficiency may occur in panhypopituitarism , in patients treated with corticosteroids or after such patients have stopped treatment.
