Synonyms: Addison’s disease, “bronze disease”, chronic insufficiency of the adrenal cortex, adrenal insufficiency.
Addison’s disease is an endocrine pathology associated with insufficient production of vital hormones by the adrenal glands. It is a consequence of failures in one of the links in the hypothalamic-pituitary-adrenal system.
Addison’s disease occurs when more than 90% of the adrenal tissue is affected. Pathology is estimated to occur in 1 patient out of 20 thousand. In most cases, the cause of the disease is an autoimmune process (an attack of its own immune system), followed by tuberculosis in frequency.
As a syndrome, chronic insufficiency of the adrenal cortex is present in a multitude of inherited diseases.
- autoimmune damage to the adrenal cortex (attack by its own immune system)
- adrenal tuberculosis
- adrenal gland removal
- effects of prolonged hormone therapy
- fungal diseases ( histoplasmosis , blastomycosis, coccidioidomycosis )
- hemorrhage in the adrenal glands
- acquired immunodeficiency syndrome (AIDS)
- genetic code abnormalities
- adrenoleukodystrophy .
Addison’s disease is accompanied by an increase in the level of adrenocorticotropic hormone (ACTH), along with alpha-melanocyte-stimulating hormone, causing darkening of the skin and mucous membranes – a hallmark of Addison’s disease, and therefore also called “bronze”.
Secondary insufficiency of the adrenal cortex due to insufficiency of the brain gland – the pituitary gland; unlike primary, it is never accompanied by darkening of the skin.
Manifestations of Addison’s disease consist of signs of insufficient release of hormones by the adrenal glands. The predominance of certain manifestations is determined by the duration of the disease.
Darkening of the skin and mucous membranes (with primary failure) is often months or years ahead of other manifestations. Darkening of the skin due to the constant stimulation of corticotrophs . Perhaps the simultaneous presence of vitiligo (lightening of the skin in chaotic areas) due to autoimmune destruction of melanocytes, cells responsible for skin coloring.
Severe weakness (primarily muscle), fatigue, weight loss, poor appetite.
Lowering blood pressure (hypotension), which is accompanied by dizziness. Also, due to low blood pressure, patients report poor cold tolerance.
Signs of gastrointestinal lesions: nausea, vomiting, episodic diarrhea.
Mental disorders (depression, psychosis) are possible.
Strengthening the taste, olfactory, auditory sensitivity; the emergence of an irresistible desire for salty food.
Adrenal (adrenal) crises
Adrenal crisis is an acutely developing condition that threatens the patient’s health and life, accompanied by a sharp decrease in the level of adrenal hormones in the bloodstream or a sudden increase in their need, provided that the function of the organs is impaired.
Causes of adrenal crisis:
Stress: acute infectious disease, trauma, surgery, emotional stress and other stressful effects. Adrenal crises in these situations provoke a lack of adequate increases in doses of hormone replacement therapy.
Bilateral hemorrhage in the adrenal glands.
Bilateral embolism of the adrenal arteries or thrombosis of the adrenal veins (for example, when conducting radiopaque studies).
Removal of the adrenal glands without adequate replacement therapy.
Manifestations of adrenal crisis:
- lowering blood pressure
- stomach ache,
- disturbance of consciousness.
Diagnosis is carried out by an endocrinologist and is reduced to the identification of insufficient functional capabilities of the adrenal cortex (to increase the synthesis of the hormone cortisol in response to stimulating effects).
First of all, it is recommended to assess the level of cortisol in the morning. If the serum index of cortisol at 8.00 in the morning is below 3 mcb / dl , they speak of adrenal insufficiency.
In the biochemical analysis of blood can be detected hyponatremia and hypokalemia . If there is a predisposition to Addison’s disease, it is recommended to monitor the level of ACTH in the blood annually. There is a gradual increase in the level of the hormone to the upper limit of normal (50 pg / ml).
Adrenal hormonal replacement therapy. Hydrocortisone and Fludrocortisone are used .
Hydrocortisone 10 mg in the morning and 5 mg orally daily after lunch (adults up to 20-30 mg / day .). An alternative to hydrocortisone is prednisone, taken once a day.
Fludrocortisone , 0.1–0.2 mg orally once a day.
With increasing blood pressure dose should be reduced. In case of an acute illness (for example, a cold) or after a minor injury, the dose of hormones is doubled up to the improvement of health.
During surgical treatment, before and (if necessary) after surgery, the dose of hormones is corrected. In case of liver diseases, as well as elderly patients, the dose of drugs should be reduced.
Women should be prescribed androgen replacement therapy. Men do not need this supplement, since they produce enough androgens in the testicles.
Diet for Addison’s disease:
Adequate amounts of proteins, fats, carbohydrates and vitamins, especially C and B (recommended rosehip decoction, black currants, brewer’s yeast).
Table salt is consumed in an increased amount (20 g / day ).
The diet reduces the content of potatoes, peas, beans, beans, dried fruits, coffee, cocoa, chocolate, nuts, mushrooms.
Vegetables, meat, fish must be consumed boiled.
Dietary fractional, before going to bed recommend a light dinner (a glass of milk).