Addison's Disease

Adrenal Insufficiency



Addison's Disease


The adrenal glands are no longer able to function due to damage to the adrenal cortex by the immune system or are insufficiently controlled by the brain (pituitary gland) and are no longer able to produce cortisol, the functioning can also be reduced by external factors such as the use of medication containing corticosteroids. The adrenal glands can fail completely over time and the patient is dependent on synthetic cortisone replacement medication for life.

Adrenal hormone



Cortisol


Is a vital hormone that is produced in the adrenal glands. Also called the stress hormone because this hormone is released during stress situations (this can also be psychological), it is a supplier of energy for the body to respond to these stress situations (flight or fight response). Cortisol has a circadian rhythm, production is not the same during the day (peak in the morning and fall in the evening).

Basic information


Different types of adrenal insufficiency:


Primary:
There is a problem of the adrenal glands themselves (this is called Addison's disease)
Secondary:
There is a pituitary gland problem (located in the brain)
Tertiary:
There is a problem with the hypothalamus (located in the brain) Steroid-induced adrenal insufficiency:
From medications that contains a synthetic form of cortisol (also called tertiary adrenal insufficiency)


Symptoms of adrenal insufficiency are mainly:


Brown discoloration of the skin (primary) General weakness, accompanied by fatigue
Weight loss due to loss of appetite
Salty craving (primary)
Gastrointestinal complaints such as nausea, vomiting and abdominal pain, diarrhea
Pain in muscles and joints Brainfog (concentration and attention problems Depressive complaints
Low blood pressure and / or blood sugar Unexplained fever
Flank pain (suspected dehydration) Problems waking up (disturbed sleep and wake rhythm)

Diagnosing the condition is a long way to go for the patient, in some cases it may be too late by suddenly having an Addisonian crisis when 90% of the adrenal glands have been destroyed.
The path to diagnosis is difficult because adrenal insufficiency is a rare condition (primary).
Many preliminary investigations can be conducted to rule out other possible conditions, including psychological problems and the appointment of a dietician.
If the complaints persist, further research is carried out such as a blood analysis and referral to a specialist, endocrinologist.
He will further investigate the cortisol levels, if these deviate further tests will be done.
There are two types of tests to see cortisol production, an ITT (insulin intolerance test) and ACTH test (also called synacthen test). In addition, a brain scan of the pituitary / hypothalamus or genetic examination can be done if indicated.
When diagnosing the condition, on the basis of which type of adrenal insufficiency, replacement synthetic cortisol (hydrocortisone) will be started immediately, the dose of which will be determined by the endocrinologist.
It can sometimes take years before the correct dose adjustment is achieved and the patient is almost completely free of complaints.
In some cases, such as with primary adrenal insufficiency, multiple medications are prescribed such as the hormone DHEA and fludrocortisone.


Different types of corticosteroids: 


  • Hydrocortisone (Solu Cortef for SC/IV/IM administration): fast working corticosteroīd
  • Prednisone: slow working corticosteroīd,

    is mainly used for infections / inflammations

  • Dexamethasone:

    is mainly used for infections / inflammations


Aldosterone (fludrocortisone):

a hormone (mineralcorticoid) produced by the adrenal gland. It plays an important role in regulating blood pressure (fluid-salt axis).

DHEA: Dehydroepiandrosterone,

a hormone produced by the adrenal gland.It is converted to androgen and estrogens in both men and women.


An underactive thyroid gland (Hashimoto / hypothyroidism) is also often diagnosed with primary or secondary adrenal insufficiency, usually some time after the diagnosis of adrenal insufficiency.
Other conditions that can be related are celiac disease, type 1 diabetes, Graves' disease.




"Diagnosis is usually not made until 90% of the adrenal glands have been destroyed, the patient has an Addisonian crisis"

"The symptoms are atypical and often overlooked in the early stages where it takes years to reach a diagnosis with sometimes fatal consequences"

"Addison's disease is a very rare condition that needs to be brought to the attention of doctors, it is not sufficiently well known"

Circadian rhythm


Schedule of cortisol production per 24 hours

Stimulation test

Example of a stimulation test to be interpreted correctly (source: OV Aalst, Belgium)

Patients with adrenal insufficiency must always have a medical SOS card in their possession in case of emergency!


Ask your doctor about the emergency syringe for an Addison crisis!

Positive ITT-test



Example of a positive ITT (insulin intolerance test) test (source: personal data)

ADSG

Adrenal Disease Support Group:

International support group on Facebook that provides a lot of information about this condition.
Experience shows that this group is indispensable for those with adrenal insufficiency.

More about adrenal insufficiency


 Information with stress schedule and stress instructions with Addison crisis available