Addison's disease

Signs and symptoms of Addison's disease usually develop slowly, often over several months, and may include:

* Muscle weakness and fatigue
* Weight loss and decreased appetite
* Darkening of your skin (hyperpigmentation)
* Low blood pressure, even fainting
* Salt craving
* Low blood sugar (hypoglycemia)
* Nausea, diarrhea or vomiting
* Irritability
* Depression

Sometimes, however, the signs and symptoms of Addison's disease may appear suddenly. In acute adrenal failure (addisonian crisis), the signs and symptoms may also include:

* Pain in your lower back, abdomen or legs
* Severe vomiting and diarrhea, leading to dehydration
* Low blood pressure
* Loss of consciousness

Your adrenal glands are composed of two sections. The interior (medulla) produces adrenaline-like hormones. The outer layer (cortex) produces a group of hormones called corticosteroids, which include glucocorticoids, mineralocorticoids and male sex hormones (androgens).

Some of the hormones the cortex produces are essential for life - the glucocorticoids and the mineralocorticoids.

* Glucocorticoids. These hormones influence your body's ability to convert food fuels into energy, play a role in your immune system's inflammatory response, and help your body respond to stress.
* Mineralocorticoids. These hormones maintain your body's balance of sodium and potassium and water to keep your blood pressure normal.

Primary adrenal insufficiency
Addison's disease occurs when the cortex is damaged and doesn't produce its hormones in adequate quantities. Doctors refer to the condition involving damage to the adrenal glands as primary adrenal insufficiency.

The failure of your adrenal glands to produce adrenocortical hormones is most commonly the result of the body attacking itself (autoimmune disease). For unknown reasons, your immune system views the adrenal cortex as foreign, something to attack and destroy.

Other causes of adrenal gland failure may include:

* Tuberculosis
* Other infections of the adrenal glands
* Spread of cancer to the adrenal glands
* Bleeding into the adrenal glands

Secondary adrenal insufficiency
Adrenal insufficiency can also occur if your pituitary gland is diseased. The pituitary gland makes a hormone called adrenocorticotropic hormone (ACTH), which stimulates the adrenal cortex to produce its hormones. Inadequate production of ACTH can lead to insufficient production of hormones normally produced by your adrenal glands, even though your adrenal glands aren't damaged. Doctors call this condition secondary adrenal insufficiency.

Another more common possible cause of secondary adrenal insufficiency occurs when people who take corticosteroids for treatment of chronic conditions, such as asthma or arthritis, abruptly stop taking the corticosteroids.

Addisonian crisis
If you have untreated Addison's disease, an addisonian crisis may be provoked by physical stress, such as an injury, infection or illness.

If you receive an early diagnosis of Addison's disease, treatment may involve taking prescription corticosteroids. Because your body isn't producing sufficient steroid hormones, your doctor may have you take one or more hormones to replace the deficiency. Cortisol is replaced using hydrocortisone (Cortef), prednisone or cortisone. Fludrocortisone (Florinef) replaces aldosterone, which controls your body's sodium and potassium needs and keeps your blood pressure normal.

In addition, your doctor may recommend treating androgen deficiency with an androgen replacement called dehydroepiandrosterone. Some studies indicate that, for women with Addison's disease, androgen replacement therapy may improve overall sense of well-being, libido and sexual satisfaction.

You take these hormones orally in daily doses that mimic the amount your body normally would make, thereby minimizing side effects. If you're facing a stressful situation, such as an operation, an infection or a minor illness, your doctor will suggest a temporary increase in your dosage. If you're ill with vomiting and can't retain oral medications, you may need corticosteroid injections.

Addisonian crisis
An addisonian crisis is a life-threatening situation that results in low blood pressure, low blood levels of sugar and high blood levels of potassium. This situation requires immediate medical care. Treatment typically includes intravenous injections of:

* Hydrocortisone
* Saline solution
* Sugar (dextrose)

All users should always seek the advice of a physician or other qualified health care provider with any questions regarding personal health or medical conditions. Never disregard, avoid or delay in obtaining medical advice from your doctor or other qualified health care provider because of something you have read on this site. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately.