Addison's disease

More than 150 years ago, Thomas Addison described a group of patients with anemia and diseased adrenal glands at autopsy, a condition now known as primary adrenal insufficiency.

Addison's disease is hypo function of the adrenal cortex. There is a decrease in adrenal steroids which are: glucocorticoids, mineral corticoids, and androgen. Addisons disease occurs when 90% of the adrenal cortex has been destroyed.

Any disease process which causes direct injury to the adrenal cortex can result in primary adrenal insufficiency (Addison disease).

In the developing world, autoimmune destruction of the adrenal glands is the most common cause of Addison disease; while, worldwide, other possible causes include infection such as sepsis, tuberculosis, and HIV, bilateral adrenal hemorrhages (secondary to sepsis, coagulopathy, or trauma), and neoplastic processes affect adrenal glands.

In the United States and Western Europe, the estimated prevalence of Addison disease is one in 20,000 persons; therefore, a high clinical suspicion is needed to avoid misdiagnosing a life-threatening adrenal crisis (i.e., shock, hypotension, and volume depletion). The clinical manifestations before an adrenal crisis are subtle and can include hyperpigmentation, fatigue, anorexia, orthostasis, nausea, muscle and joint pain, and salt craving.

The symptoms of adrenal insufficiency usually begin gradually. The most common symptoms are
• chronic, worsening fatigue
• muscle weakness
• loss of appetite
• weight loss

Other symptoms can include
• nausea
• vomiting
• diarrhea
• low blood pressure that falls further when standing, causing dizziness or fainting
• irritability and depression
• a craving for salty foods due to salt loss
• hypoglycemia, or low blood glucose
• headache
• sweating
• in women, irregular or absent menstrual periods
Addison's disease