Addison’s disease – symptoms, examination and treatment

Addison’s disease is a hormonal disease that is also commonly called primary adrenal insufficiency. The disease causes the adrenal glands to not produce enough cortisol and aldesterone.

Fatigue and abdominal pain are some of the symptoms of Addison’s disease. There are about 1,300 people in USA who suffer from the disease. Here you can learn more about Addison’s disease, such as symptoms, examinations and how it is treated.

Symptoms of Addison’s disease

The symptoms of Addison’s disease vary between different people, both in terms of strength and which of the signs appear. They also differ slowly and may be difficult to distinguish from symptoms that may appear for other reasons. It is common to have several of these symptoms:

  • weakness
  • Weight loss
  • Changed skin pigmentation (especially greyish complexion in areas exposed to sun)
  • Dizziness (due to low blood pressure)
  • Abdominal pain, nausea and vomiting
  • Muscle and joint pains
  • Suck for salty food
  • Reduced sexual desire and decreased hairiness in the armpits and abdomen (women)

Causes of Addison’s disease

Most cases of Addison’s disease are due to autoimmune diseases that destroy the adrenal cortex. The body’s own immune system thus attacks the adrenal cortex and causes adrenal cortex failure. Therefore, Addison’s disease is called primary adrenal gland failure; the adrenal cortex is damaged and does not work properly. Between 80 and 90 percent of cases in Europe are due to autoimmunity.

Common to have other autoimmune diseases or sequelae

When you have Addison’s, it is common to also have other autoimmune diseases or sequelae. Nearly half have hypothereosis, impaired thyroid function. Vitamin B12 deficiency, type 1 diabetes and vitiligo are other conditions that are more common in those with Addison’s disease.

Addison Crisis

Addison’s disease can also lead to more severe symptoms that come suddenly, such as severe weakness and fatigue, dizziness and fainting, fever, nausea and vomiting. These more severe symptoms can also occur if you have already been diagnosed. It is usually called Addison crisis.
An Addison crisis means that you have a cortisol deficiency. Most often, cortisol deficiency occurs if you become ill or suffer an accident. Call 112 immediately if you suspect you have an Addison crisis.

Addison’s disease and stomach upset

If you have been diagnosed with Addison’s disease and become stomach-sick with symptoms such as diarrhea and vomiting, you need to seek care quickly. The reason is that the body then cannot absorb the hormones from the Addison treatment. It can lead to an Addison crisis, and also increases the risk of dehydration and fluid deficiency. Remember to always tell you that you have Addison’s disease when you seek care.

About cortisol and aldosterone

Cortisol and aldosterone are the two hormones lacking in Addison’s disease. Cortisol helps the body cope with stress. The amount of cortisol changes when the body is exposed to stress; it rises a little closer to everyday stress and a lot to high fever, infections and injuries. Aldosterone regulates the amount of salt and water in the body, which, for example, affects blood pressure.

Treatment of Addison’s disease

The treatment of Addison’s disease consists of replacing the deficiency of cortisol and aldosterone in the body. This should be inserted as soon as possible after diagnosis. The improvements are often noticed quickly, already within a day. The drugs are taken as tablets. In case of severe symptoms, the drugs are initially given directly into the blood.

The lack of cortisol and aldosterone is compensated by giving drugs containing hydrocortisone (replacing cortisol) and fludrocortisone (replacing aldosterone). Sometimes drugs are also taken to replace sex hormones that are formed in the adrenal glands. This may be needed if Addison’s disease leads to problems with reduced sex drive.

The treatment of Addison’s disease continues throughout life, and you need to take the tablets every day. The doctor determines the dosage and how often the medicines need to be taken. The dosage of the medication is adjusted so that the levels reach the body’s natural levels of cortisol and aldosterone. The amount of cortisone inserted may need to be increased if the body is subjected to stress, for example during a fever, dental operation, illness or other injury.

Addison’s disease and pregnancy

Addison’s disease does not change the chances of getting pregnant or making someone pregnant. It also does not affect the ability to breastfeed their baby. However, you should tell your doctor if you are pregnant or have plans to have a baby. The reason is that you may need to increase the drug dose slightly, in consultation with your doctor, and that extra cortisone may be needed at birth.

The drugs used in Addison’s disease are risk-free for the children because the hormone levels in treatment are the same as in a healthy person.

Information card “Important information about cortisol deficiency”

Those who have Addison’s disease should always carry with them the information card “Important information about cortisol deficiency”, for example in the wallet. The card has been developed by the American Addison Register together with the American Endocrinological Association. It is a card with information about Addison’s disease in both American and English. The reason is that cortisol must be given on contact with health care, for example if you need an operation or have an accident.

Care and diagnosis of Addison’s disease

If you think you have Addison’s disease, you should contact a health care center or an on-call clinic. If the health center or reception is closed, you can wait until it opens, provided you do not have severe symptoms such as severe fatigue and dizziness while having a fever, stomach ache or nausea and vomiting. Call 911 for medical advice in case of uncertainty about symptoms.

When you meet a doctor to check if you have Addison’s, you are usually told about their symptoms, undergo a physical examination, measure blood pressure and submit blood tests. The blood sample may need to be left in the morning as the cortisol level in the blood needs to be measured. Further investigation of the adrenal gland’s production of cortisol may be needed, a so-called ACTH or Synacthen test.

It is common for people to become sick during the first few weeks after diagnosis. Often you still feel weak at the beginning of the medication, and it may take time to understand what Addison’s disease and its treatment mean. During the first few years, people visit again a couple of times a year. Then it will usually be about once a year. On the return visits, take blood tests and other examinations to see how the treatment works.

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