Contents
1. Etiology (Causes)
Addison’s disease (primary adrenal insufficiency) occurs when the adrenal cortex is damaged, leading to deficient production of:
- Cortisol (stress hormone)
- Aldosterone (regulates salt/water balance)
Main Causes:
✔ Autoimmune destruction (80% of cases) – Body attacks adrenal cortex
✔ Infections (TB, HIV, fungal infections)
✔ Cancer metastasis (rare)
✔ Genetic disorders (e.g., adrenoleukodystrophy)
✔ Bilateral adrenal hemorrhage (e.g., from sepsis or anticoagulants)
2. Symptoms
Early Stage:
- Fatigue & muscle weakness
- Weight loss & decreased appetite
- Salt cravings
- Low blood pressure (dizziness when standing)
Advanced Stage:
- Hyperpigmentation (darkening of skin creases, gums)
- Nausea/vomiting
- Abdominal pain
- Adrenal crisis (life-threatening):
- Severe vomiting/diarrhea
- Confusion
- Loss of consciousness
3. Diagnosis
Key Tests:
- Morning cortisol blood test (low)
- ACTH stimulation test (no cortisol rise)
- Electrolytes (low sodium, high potassium)
- Autoantibodies (anti-adrenal antibodies)
- Imaging:
- CT adrenal glands (check for TB, hemorrhage)
- Chest X-ray (if TB suspected)
4. Treatment
Lifelong Hormone Replacement:
- Hydrocortisone (10-20 mg/day) – Replaces cortisol
- Fludrocortisone (0.05-0.2 mg/day) – Replaces aldosterone
Emergency Care for Adrenal Crisis:
- Immediate IV hydrocortisone + saline
5. Prevention
❗ No way to prevent autoimmune form, but you can:
- Treat infections (e.g., TB) early
- Manage stress (physical/emotional)
- Always carry a steroid emergency card/bracelet
6. When to See a Doctor?
Seek help if you have:
- Unexplained weight loss + fatigue
- Darkening skin (especially palms/scars)
- Dizziness + salt cravings
- Symptoms of adrenal crisis (requires ER visit)
7. How to Avoid Complications?
- Never skip medications (risk of crisis)
- Double hydrocortisone dose during illness/surgery
- Regular check-ups (electrolytes, blood pressure)
- Vaccinations (prevent infections that could trigger crisis)
- Addison’s is rare but serious – needs lifelong treatment.
- Early diagnosis prevents crises (which can be fatal).
- Patients must always carry emergency steroids.
Did you know? John F. Kennedy had Addison’s disease!
