Addison’s disease is a rare disorder. It happens when the adrenal glands are not producing a sufficient amount of steroid hormones. This is found through medical imaging and blood tests. The disease got its name from Thomas Addison, the famous doctor who also discovered malaria.
There are many causes of this disease, which include autoimmune processes in the body or long-term steroid use which suppresses the body’s natural function. (This is called secondary adrenal insuffiency)
Since symptoms don’t reveal themselves easily, Addison’s cannot be detected very easily. The patient may experience some symptoms such as fatigue, fever, and weight loss. Patients also suffer low energy and difficulty standing, low blood pressure, and a desire for salty foods as sodium gets washed out with the urine. Patients may experience some tanning of the skin due to hyperpigmentation.
In its early stages, adrenal insufficiency can be difficult to diagnose. The medical team will review the patient’s medical history, and symptoms, especially tanning of the skin, will help to identify the condition. Laboratory tests will determine whether levels of cortisol are sufficient and establish the cause. X-rays of the adrenal and pituitary glands will also help establish a diagnosis.
The most specific test to diagnose Addison’s disease is the ACTH stimulation test. It measures blood and urine cortisol after receiving an injection of ATCH. There is a rapid test also where measurements of cortisol are taken after 30 and 60 minutes after injection. In a healthy person, the cortisol will rise in blood and urine; however, in a person with Addison’s disease, there will be little to no change in cortisol levels.
When an abnormal response to the ACTH test is present, a longer CRH stimulation test is applied to determine the cause of the adrenal insufficiency. In this test, synthetic CRH is given intravenously and blood cortisol is measured in intervals over a two-hour period. Patients having primary adrenal insufficiency have high ACTH’s but do not produce cortisol. Patients with secondary adrenal insufficiency have deficient cortisol responses, but absent or delayed ACTH responses. An absent ATCH response is caused by the pituitary, where a delayed response points to the hypothalamus.
When a patient is diagnosed with Addison’s or in crisis, the doctor will begin treatment with injections of salt, fluids and glucocorticoid hormones immediately. A reliable diagnosis is not possible while a patient is being treated in crisis; however, it is enough to diagnose the condition. Once the crisis is controlled, and medication has been stopped, the doctor will delay further testing for up to one month in order to obtain an accurate diagnosis.
At that time, x-ray exams of the abdomen will be taken in order to see if the adrenal glands have signs of calcium deposits, which may indicate tuberculosis. If a secondary adrenal insufficiency is the cause, doctors may use other imaging tools to examine the pituitary gland.
Addison’s disease can be treated by introducing cortisone to the body via tablets. This is a lifetime treatment. Sometimes, injections of cortisones can be increased, as when the patient is suffering a trauma, is suffering an infection, or is pregnant. It is recommended that the patient wear a medical alert bracelet, so if the patient suffers a trauma, the medical team knows that the patient will need additional cortisone treatment.
There is hope for people who have Addison’s disease. It does require proper monitoring, and patients must understand the importance of monitoring their health. It is also important to carry identification and medical alert information in case of accident.