Addison’s disease, according to Mayo Clinic, is a disease cause by a insufficient amount of hormones that come from the adrenal gland. Typically what is found in individuals with Addison’s disease is a limited amount of cortisol along with limited amounts of aldosterone also. i Adrenal crisis also occurs when there is not enough cortisol in the body, on a more dangerous level. v It usually occurs when the adrenal gland is damaged severely or Addison’s disease is not treated properly. v To understand what is happening when a person experiences Addison’s disease or adrenal crisis it is important to understand what is happening inside the body. The adrenal gland is located upon each of the kidneys.
It has two parts, one focuses on the sympathetic nervous system while the other is the part that is actually made up of the glandular tissue. ii The part that is made up of glandular tissue is called outer adrenal cortex. ii This outer adrenal cortex is known to produce many different proteins which together are known as corticosteroids. ii They can also be broken down into aldosterone, cortisol, and androgens. iv The cortisol is bound together with a protein and together they are called glucocorticoids. iv This has many important jobs in the body.
Some of the jobs of the glucocorticoids are to stimulate gluconeogenesis, mobilizes fatty acids and amino acids, elevate red blood cells and platelets, decrease cellular glucose use, and to cause anti-inflammatory effects. iv Without cortisol the liver doesn’t store glycogen as well, there is an increase of insulin sensitivity, and the metabolism of proteins decreases. iii Aldosterone also has many important jobs in the human body. Some of the jobs aldosterone are to cause the gut, kidneys, sweat, and salivary glands to balance the electrolyte levels in the body.
iv Some clinical manifestations that come along with Addison’s disease are fatigue and weakness that progresses as the day goes on, hypoglycemia, gastrointestinal disturbances, and hyperpigmentation. iii There are many causes of Addison’s disease. It can result from damage to the adrenal gland making it not produce enough cortisol to satisfy the body. i The most common reason is an autoimmune disease. i There are other causes that are known to cause adrenal gland failure. Tuberculosis, cancer in the adrenal gland, bleeding in the adrenal gland, and an infection in the adrenal gland are all causes of the adrenal gland failing. i These causes are directly dealing with the adrenal gland, but there are other secondary causes of Addison’s disease.
i The pituitary gland is the gland that regulates and stimulates the adrenal cortex. If there is a disease or the pituitary gland or other reasons that it is not functioning properly it will result in the adrenal gland not receiving the messages from the pituitary gland. i Another secondary cause is when people are taking corticosteroid as a form of treatment stop taking their medication suddenly.
i There are also many causes of adrenal crisis many of which first begin as Addison’s disease not being properly treated. i If an individual with Addison’s disease experiences physical stress they may cause themselves to have adrenal crisis. i Adrenal crisis may also be cause by an individual discontinuing their corticosteroid suddenly. vii It may also be caused by septic shock. vii There are many signs and symptoms of Addison’s disease. They will develop slowly over the span of several months. i Most often they will not show unill about 90% of the cortex of the adrenal gland is damaged or destroyed.
ii The individual may experience fatigue and muscle weakness that progresses as the day goes on. i They may lose weight and their appetite. i Their skin color may darken, which is known as hyperpigmentation. i They may have low blood pressure, which is known as hypotension. i The individual may have salt cravings and low blood sugar. i Low blood sugar is also known as hypoglycemia. They may have gastrointestinal issues such as vomiting, diarrhea, or nausea. i The individual may have pain in their muscles and joints. i They may be irritable and depressed.
i Women with Addison’s disease may lose body hair and have sexual dysfunction. i Adrenal crisis signs and symptoms on the other hand are very sudden. Some of the signs are similar to that of Addison’s Disease. An individual with adrenal crisis may also have pain but it is in their lower back, legs, and abdomen instead of their joints. i They may also have gastrointestinal issues in a more severe form often leading to dehydration. i The individual’s blood pressure will be low and they may lose consciousness. i They will also have hyperkalemia, which is high potassium. i The only treatment of adrenal crisis that is definite is to give the individual glucocorticoids in stress doses.
iv Glucocorticoid effects are facilitated by cytosolic glucocorticoid receptors which cause the therapeutic results, but many of the desired responses are from the transpression. viii Transpression reduces the amount of proinflammatory proteins on a cellular level . viii Most often the individual will have to get other treatments along with the glucocorticoids to replace fluid and electrolytes. iv This will raise the individuals fluid levels and balance their electrolytes. Most individuals will experience hyperkalemia and will have to treated for it.
iv Hyperkalemia occurs when the potassium level in the individuals blood is higher than normal. The individual may also experience hypotension, which pressors such as norepinephrine and dopamine may be needed. iv These pressors will raise the individuals blood pressure. There are many treatments for Addison’s disease. Although they are not all as urgent as adrenal crisis it is very important to treat so it will not become fatal. All of the treatment for Addison’s disease is focused on replacing the hormones to the proper levels. i There are different options to replace the hormones that are missing.
Oral corticosteroids are used to replace both cortisol and aldosterone. i Fludrocortisone is used to replace the aldosterone and cortisone hydrocortisone, or prednisone is used to replace cortisol. i Injections may be used if gastrointestinal issues are not allowing the individual to take them orally. i Another treatment of aldosterone replacement is dehyroepiandrosterone. i This not only replaces the aldosterone lost it also give the individual libido and an overall sense of wellbeing. i All of the hormone replacement treatments are used to reduce the signs and symptoms of Addison’s disease.
When replacing cortisol it reduces it not only treats the signs and symptoms of Addison’s disease is will also control the inflammation that is accompanying this autoimmune disease. ii There are other treatments that are sometimes overlooked because they do not directly deal with the hormone replacement but rather other aspects of the disease. Dieting is an important part. ii Reducing the amount of sugar intake will allow the immune system to function better. ii Reducing the amount of caffeine intake will help because caffeine puts the adrenals into a sympathetic nervous mode.
ii Therapy may also help people with Addison’s disease by reducing the amount of stress in their life which worsens the disease. ii Rest is also important because they people tire easily and wear themselves out which is not beneficial to their body or their disease. ii With the gastrointestinal issues that go along with Addison’s disease it is important to focus on the individual nutrition and dietary supplements may be necessary to keep the individual healthy as possible. ii Addison’s disease and adrenal crisis have many things in common including some of the signs symptoms.
They come from the same background in that they both are lacking in the proper hormones the body needs to survive. Some of the main differences are the severity of adrenal crisis is higher that Addison’s disease resulting in different treatments, as listed above. Another difference is how long it takes for the signs and symptoms to show. Addison’s disease symptoms appear over months, while adrenal crisis is sudden and severe. Addison’s disease can affect people of all ages, but most often occurs in ages 30-50 years old. iv Men and women have been found to be affected equally, but women
experience more of the autoimmune causes of Addison’s disease than men. iv Women experience the autoimmune form 2-3 times as often as men. iv Addison’s disease is not required to report so the numbers are not 100% accurate. Because Addison’s disease symptoms are slow to progress and sometimes do not show until later in the disease process there are many cases that are yet undiagnosed causing a difference in the numbers. According to Kevin Klauer with Medscape, in the United States it is not very common. iv He found there to be approximately 50 cases of Addison’s disease per 1,000,000 people. iv He also was able to estimate that there is approximately 6,000,000 cases in the United States that are undiagnosed.
iv The number of cases that are still undiagnosed have a very large effect on the number of cases in the United States. There is such a large vary in statistics due to these factors the morbality rate is still unknown. vi Adrenal crisis is similar to Addison’s disease in that the numbers vary greatly due to it not being required to report. Adrenal crisis is life-threatening if it is not taken care of soon enough.
i MayoClinicStaff. “Addison’s Disease. ” Symptoms. MayoClinic, 4 Dec. 2012. Web. 05 June 2014. <http://www. mayoclinic. org/diseases-conditions/addisons-disease/basics/sympto ms/con-20021340>. ii Hegnauer, Amanda, ND. “NDNR. ” Addison’s Disease. NDNR, 3 Apr. 2014. Web. 06 June 2014. <http://ndnr. com/autoimmuneallergy-medicine/addisons-disease/>. iii McCance, Kathryn L. “Pathophysiology. ” Google Books. E1lsevier, 1 Jan. 2014. Web. 06 June 2014. <http://books. google. com/books? id=3QgyAgAAQBAJ&pg=PA758 &lpg=PA758&dq=addison’s+disease+clinical+manifestations+gross+level&sourc
e=bl&ots=_9BR_WI3LT&sig=1fnOA8Ya-L1hIABLGSg77MkAAgw&hl=en&sa=X& ei=81SPU5m5Ji bNsQTU2oHQDw&ved=0CFoQ6AEwCQ#v=onepage&q=addiso n’s%20disease%20clinical%20manifestations%20gross%20level&f=false>. iv Kirkland, Lisa, MD. “Adrenal Crisis. ” Adrenal Crisis. Medscape, 11 Mar. 2014. Web. 06 June 2014. <http://emedicine. medscape. com/article/116716-overview#a010 4>. v Wisse, Brent, MD. “Acute Adrenal Crisis: MedlinePlus Medical Encyclopedia. ” U. S National Library of Medicine. U. S. National Library of Medicine, 11 Jan. 2013. Web. 06 June 2014. <http://www. nlm. nih. gov/medlineplus/ency/article/000357.
ht m>. vi Kirkland, Lisa, MD. “Adrenal Crisis. ” Adrenal Crisis / Cushing-Help. com Support for Cushing’s Syndrome and Cushing’s Disease. Cushings Help2, 2 Feb. 2014. Web. 06 June 2014. <http://www. cushings-help. com/adrenal-crisis. htm>. vii Kirkland, Lisa, MD. “Adrenal Crisis. ” Adrenal Crisis. Medscape, 11 Mar. 2014. Web. 06 June 2014. <http://emedicine. medscape. com/article/ 765753-overview#a0199 >. viii Saag, Kenneth G. , MD. “Major Side Effects of Systemic Glucocorticoids. ” Major Side Effects of Systemic Glucocorticoids. UpToDate, 1 July 2013. Web. 06 June 2014.