By Dr. Sunita Sayammagaru, Endocrinology
The body is managed by multiple chemicals called hormones which regulate the various body functions and metabolism. The glands which produce these hormones are known as endocrine glands, as they secrete (crine) hormones or other products directly into (endo) the body. One such endocrine gland is the adrenal, which is located above the kidneys. These glands secrete the hormones known as cortisol and aldosterone, which are primarily responsible for the body’s stress response.
Types: Addison’s disease is also known as adrenal insufficiency or hypoaldosteronism. It is caused due to reduced amounts of these two hormones. In primary Addison’s disease, which is usually a hereditary autoimmune disease, there are inadequate amount of production of these hormones. The problem lies within the adrenal gland. In secondary Addison’s disease, the master endocrine gland, which is the pituitary gland, fails to send proper signals for the proper production of the adrenal hormones. There is a hormone called adrenocorticotrophic hormone or ACTH which the pituitary produces, which regulates the production of adrenal hormones. If ACTH is not produced, it leads to adrenal insufficiency, which is known as secondary Addison’s disease.
Causes and risk factors: Primary Addison’s disease is an autoimmune disorder wherein the body reacts against its own tissues and produces antibodies. In addition, prolonged use of steroids like prednisone, and chronic infections and tumours can also result in this condition.
Secondary Addison’s disease is common in people who are on corticosteroids for prolonged periods (e.g. asthmatics, arthritis patients)
Symptoms: The symptoms are detected usually when some other work is being done. Symptoms to suspect hypoaldosteronism would include muscle weakness, reduced blood pressure, and general fatigue, tiredness, darkening of the skin, weight loss, fainting spells, salt cravings, depression, and irritability.
Addisonian crisis: When a person is exposed to extreme stress, infection, injury, or illness, untreated Addison’s disease could lead to Addisonian crisis which is a life-threatening situation. This is when the person develops mental status changes like confusion, fear, and restlessness. This is primarily due to the inability to deal with stress. There could also be sudden and severe muscle pain, loss of consciousness, and high fever. Tests would reveal low potassium levels, low blood sugar, and low blood pressure. If untreated, it could even lead to death.
Treatment: Addisonian crisis would require immediate substitution of the hormones through injections. Once the normal status is achieved, then maintenance doses would be required.
For people who are diagnosed with adrenal insufficiency, it is important that medication dosages are followed regularly. These medications would be hormone replacement therapy, aimed at giving the body the required doses of adrenal hormones. Periodic visits to adjust the dose may also be required. Stress management would also be needed to address this condition effectively.