Addison's Disease and the Adrenal Glands

Addison's Disease and the Adrenal Glands

Written by Ben Bunting: BA(Hons), PGCert. Sport & Exercise Nutrition. British Army Physical Training Instructor (MFT).  

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The adrenal glands are two small organs that sit atop each kidney. They make hormones that help your body regulate blood pressure and water and salt levels.

If the adrenal glands don't make enough of these hormones, Addison's disease is the result. It can be caused by a problem with your immune system, which attacks your adrenal glands and disrupts their function.

A problem with your immune system usually causes this type of adrenal insufficiency. Your immune system mistakes your adrenal glands for a virus or bacteria and attacks them which leads to damage.

This condition is also known as primary adrenal insufficiency. It is rare, but it can happen to anyone at any age.

The treatment for Addison's disease involves medication to replace the missing hormones. This is a very safe and effective form of treatment for many people with Addison's.

You should take a daily steroid medication to keep your adrenal glands functioning normally for the rest of your life. 

Symptoms

Addison's disease is caused by your immune system attacking your adrenal glands, causing damage to the outer part of the gland (the adrenal cortex). This damages your adrenal glands and makes them unable to produce the steroid hormones cortisol and aldosterone.

The steroid hormones your adrenal glands make are essential for your body to function properly. They regulate blood sugar, food metabolism, energy levels and body fat. They also regulate your sodium, fluid balance and blood pressure.

Your adrenal glands sit atop your kidneys, and they work in partnership with the pituitary gland and your immune system to help you manage stress. Your pituitary gland produces a hormone called adrenocorticotropic hormone (ACTH) that triggers your adrenal glands to make the hormones cortisol and aldosterone.

Without these regulating hormones your body can't cope with stressful situations or recover from illness. You may experience low blood pressure (hypotension), feeling weak or fatigued, and blotchy dark tanning of your skin.

Symptoms tend to develop slowly over months and years. They can get worse when you're under extra stress, such as after a serious illness or accident.

One of the most common symptoms is weakness, which can cause dizziness and fainting, especially if you stand up. It can lead to dehydration and is a sign that you need to see a doctor immediately.

It can also be a sign that you need to increase your salt intake. Your doctor might advise you to take a high-salt diet, which is particularly important in hot weather and after intense exercise.

Your health service might order blood tests to check your blood's sodium and potassium levels. They might also check for infection, cancer, or bleeding in your adrenal glands.

Once diagnosed, your doctor will prescribe hormone replacement therapy. This can include hydrocortisone, a steroid hormone that replaces cortisol, or fludrocortisone, a steroid that replaces aldosterone.

Another treatment is to reduce the amount of salt in your diet. You can't stop taking these drugs, but you need to monitor how much you eat so that you don't become too hungry.

Diagnosis

Your body uses chemical messengers (called hormones) to regulate many functions. These hormones help you stay healthy. One of these hormones is cortisol, which helps you control your energy levels and protects you against disease. Your adrenal glands are located just above each kidney and make this hormone.

When your adrenal glands can't make enough cortisol, you have Addison's disease. Your doctor will diagnose this condition by doing a physical exam and examining your blood for levels of hormones. They may also order lab tests to check your potassium and sodium levels.

There are two main types of Addison's disease: primary adrenal insufficiency and secondary adrenal insufficiency. The former happens when your adrenal glands can't produce hormones because they're damaged. It's most common in people who have autoimmune disease, which is when your immune system mistakenly attacks your organs.

The other type of Addison's disease is secondary adrenal insufficiency, which occurs when your pituitary gland can't make a hormone called adrenocorticotropic hormone (ACTH). ACTH controls the release of hormones from your adrenal glands.

A person's immune system may attack the adrenal glands when there is another problem, such as cancer. They may also have an autoimmune disease, where your immune system mistakes one part of your body for a virus or bacteria.

Sometimes your doctor will also need to check your blood for other conditions that can cause adrenal insufficiency, such as diabetes or hypothyroidism. They will do a test called an adrenocorticotropic stimulation test, which measures the amount of hormones released from your adrenal glands.

Your doctor may need to take a blood sample from your arm, or you may have an ultrasound or an MRI scan of your adrenal glands. They can also do a urine test to see if you're producing a lot of waste products.

Your doctor may ask you to do a few tests, including blood and urine tests. They may also use X-rays or imaging scans to see whether your adrenal glands are working properly.

You may also be referred to an endocrinologist for further testing and diagnosis. An endocrinologist is a medical specialist with expertise in treating conditions like Addison's disease.

Getting diagnosed early can improve the chances of living a normal, healthy life. In addition, early treatment can reduce your risk of developing a serious and potentially life-threatening condition called an adrenal crisis, which can happen when you have a severe episode of fatigue or low blood pressure.

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Treatment

Cortisol and aldosterone are two of the most important hormones produced by the adrenal glands. These hormones are essential to your health, regulating everything from your sugar (glucose) control to your immune response.

Glucocorticoid hormones like cortisol maintain sugar control, lower the immune system's response to infection and stimulate your metabolism. They also affect your appetite, sleep patterns, and mood.

Another key hormone, aldosterone, helps your kidneys to absorb sodium and potassium. When aldosterone levels are too low, the salt and water levels in your body become unbalanced, leading to high blood pressure.

If you have Addison's disease, your GP will prescribe medication to replace the hormones that your adrenal glands are no longer producing. This usually involves taking tablets 2 or 3 times a day. 

In some cases, your doctor may prescribe a drug that can increase your body's ability to produce cortisol and aldosterone, called an agonist. The agonist can be taken in tablet form or as a liquid.

The agonist can be given at different doses and is often prescribed for a long period of time, up to several years. In severe cases, the agonist may need to be changed periodically or added to a more effective medicine.

If you have Addison's disease, it's important that you always follow the medicines your doctor prescribes. If you stop taking them, your symptoms could get worse. This is called an adrenal crisis and can be dangerous if you don't get treated quickly.

Is Addison's Disease Fatal?

Typically, people with Addison's disease can live normal, long lives. The disease can develop as an autoimmune disorder or as a result of an infection, such as tuberculosis or HIV.

Symptoms usually don't appear until the adrenal glands are about 90 percent destroyed. The condition is most often diagnosed in 30 to 50-year-olds with autoimmune polyendocrine syndrome, but can affect anyone at any age.

The signs of Addison's disease are similar to those of other health problems, including low blood pressure, disturbed salt levels and blotchy, dark tanning or freckling of the skin, especially on areas that rub against other objects (e.g., the armpits, elbows and knuckles).

Some people with Addison's disease develop an adrenal crisis. This occurs when cortisol and aldosterone are both lower than normal.

Adrenal crises can be a warning sign of an underlying problem, and are treated immediately with hydrocortisone injections and intravenous fluids. They are also treated with other medications that help replace the hormones that are missing.

An adrenal crisis can be fatal if left untreated, so it's important to talk with your doctor and get medical care immediately.

The symptoms of Addison's disease may not be noticed until a stressful event causes them to worsen. For one in four people with the disease, this is the first time they realize they are sick. During this time, they need urgent treatment with hydrocortisone and other medication to prevent further damage to the adrenal glands and kidneys.

Addison's Disease and the Adrenal Glands Conclusion

The adrenal glands, located on top of each kidney, are part of your endocrine (hormone) system. They produce hormones that help your body cope with stress and other challenges. These hormones include cortisol and aldosterone, which regulate blood pressure and sodium levels in the body.

Your adrenal glands may not work properly if you have autoimmune Addison's disease. This happens when the immune system makes antibodies that attack and destroy the adrenal glands. This is usually caused by an autoimmune disease, such as lupus, but it can also be caused by infections, cancer, blocked blood vessels and surgery.

Tests to diagnose Addison's are usually done by an endocrinologist, a doctor who specializes in hormones. The tests can measure the levels of cortisol, sodium and potassium in your blood. They can also measure the level of adrenocorticotropic hormone (ACTH) in your blood, which tells your adrenal glands to make more cortisol.

Treatment of Addison's is usually a combination of medications that replace hormones that the adrenal glands can't produce. Your doctor will create a personalized treatment plan for you and give you instructions on how to take your medications.

Symptoms of Addison's vary from person to person, but some common ones are fatigue, loss of appetite, weight gain or weight loss, irritability and depression. Some people with Addison's develop small areas of dark skin, and they might also have problems with their menstrual periods or a lack of libido.

If you suspect that you may be suffering from Addison's diseae it is important to confim this with a medicla diagnosis.

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