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== Addison's Disease == | == Addison's Disease == | ||
Addison’s disease is another name for primary chronic adrenal insufficiency. It is a condition where the adrenal cortex (the outer layer of the adrenal gland that produces mineralocorticoids, glucocorticoids, and androgens) is progressively destroyed, resulting in decreased secretions of hormones.<ref name="Goodman, Fuller">Goodman CC, Fuller KS. Pathology: Implications for the Physical Therapist. St. Louis: Elsevier; 2009.</ref><ref name="Kumar, Abbas">Kumar V, Abbas AK, Fausto N. Pathologic Basis of Disease. Philadelphia: Elsevier; 2005.</ref> Cortisol, a glucocorticoid, and aldosterone, a mineralocorticoid, are the hormones that are affected by Addision's disease causing a global metabolic disorders and fluid imbalance.<ref name="Goodman, Fuller" />In the developed world, Addison's disease is most commonly caused by autoimmune disease however worldwide, tuberculosis is the most common cause. | Addison’s disease is another name for primary chronic [[Adrenal Glands|adrenal]] insufficiency. It is a condition where the adrenal cortex (the outer layer of the adrenal gland that produces mineralocorticoids, glucocorticoids, and androgens) is progressively destroyed, resulting in decreased secretions of hormones.<ref name="Goodman, Fuller">Goodman CC, Fuller KS. Pathology: Implications for the Physical Therapist. St. Louis: Elsevier; 2009.</ref><ref name="Kumar, Abbas">Kumar V, Abbas AK, Fausto N. Pathologic Basis of Disease. Philadelphia: Elsevier; 2005.</ref> Cortisol, a glucocorticoid, and aldosterone, a mineralocorticoid, are the hormones that are affected by Addision's disease causing a global [[Metabolic and Endocrine Disorders|metabolic]] disorders and fluid imbalance.<ref name="Goodman, Fuller" />In the developed world, Addison's disease is most commonly caused by autoimmune disease however worldwide, [[tuberculosis]] is the most common cause. | ||
Adrenal insufficiency may also be caused by long-term administration of corticosteroids or disorders of the hypothalamus or pituitary gland, but this is not Addison's disease.<ref name=":1">NICE | Adrenal insufficiency may also be caused by long-term administration of [[Corticosteroid Medication|corticosteroids]] or disorders of the [[hypothalamus]] or pituitary gland, but this is not Addison's disease.<ref name=":1">NICE. Addison's disease. Available at:https://cks.nice.org.uk/addisons-disease#!topicSummary (Accessed 29 June 2020) | ||
Addison's disease | |||
https://cks.nice.org.uk/addisons-disease#!topicSummary | |||
</ref> | </ref> | ||
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== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
The adrenal (suprarenal) glands are endocrine glands that are located superior to the kidneys. The adrenal glands have two layers the adrenal cortex (the outer layer) that is responsible for producing steroid hormones and the inner layer the medulla which is responsible for secreting the hormones that control our stress response, commonly referred to as our fight or flight response<ref name=":0">The Johns Hopkins Hospital, and Johns Hopkins Health System | The adrenal (suprarenal) glands are endocrine glands that are located superior to the kidneys. The adrenal glands have two layers the adrenal cortex (the outer layer) that is responsible for producing steroid hormones and the inner layer the medulla which is responsible for secreting the hormones that control our stress response, commonly referred to as our fight or flight response<ref name=":0">The Johns Hopkins Hospital, and Johns Hopkins Health System. Adrenal Glands. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/adrenal-glands#:~:text=Adrenal%20glands%2C%20also%20known%20as,stress%20and%20other%20essential%20functions. (Accessed 29 June 2020)</ref> | ||
=== The Adrenal Cortex === | === The Adrenal Cortex === | ||
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== Prevalence == | == Prevalence == | ||
Addison’s disease occurs in about 1 in 100,000 Americans<ref>NORD | Addison’s disease occurs in about 1 in 100,000 Americans<ref>NORD. Addison’s Disease. Available at https://rarediseases.org/rare-diseases/addisons-disease/ (Accessed 29 June 2020)</ref>. About 8,400 people are currently diagnosed with Addison's disease in the UK<ref name=":1" />. Even though it is seen throughout the lifespan in both genders, it most commonly occurs in middle-aged white females. | ||
== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
Addison’s disease will develop insidiously, with the signs of the disease not developing “until at least 90% of both glands is destroyed and the levels of circulating glucocorticoids and mineralocorticoids are significantly decreased.”<ref name="Kumar, Abbas" /> Some of the clinical signs and symptoms of Addison’s disease include: | Addison’s disease will develop insidiously, with the signs of the disease not developing “until at least 90% of both glands is destroyed and the levels of circulating glucocorticoids and mineralocorticoids are significantly decreased.”<ref name="Kumar, Abbas" /> Some of the clinical signs and symptoms of Addison’s disease include: | ||
* Darkened pigmentation of the skin (especially of the mouth and scars), due to increased secretion of melanin-secreting hormone (MSH) corresponding with increased secretion of ACTH, which is released to try to stimulate the work of the adrenal glands<ref name="Goodman, Fuller" /><ref name="Kumar, Abbas" /> | * Darkened pigmentation of the skin (especially of the mouth and scars), due to increased secretion of melanin-secreting hormone (MSH) corresponding with increased secretion of ACTH, which is released to try to stimulate the work of the adrenal glands<ref name="Goodman, Fuller" /><ref name="Kumar, Abbas" /> | ||
* Slowly developing weakness and fatigue<ref name="Kumar, Abbas" /><ref name="Goodman, Snyder">NHS | * Slowly developing weakness and fatigue<ref name="Kumar, Abbas" /><ref name="Goodman, Snyder">NHS. Bone density scan (DEXA scan). Available at https://www.nhs.uk/conditions/dexa-scan/what-happens/ (Accessed 29 June 2020)</ref> | ||
* Hypotension due to increased sodium excretion from decreased aldosterone secretion<ref name="Goodman, Fuller" /><ref name="Kumar, Abbas" /><ref name="Goodman, Snyder" /> | * Hypotension due to increased sodium excretion from decreased aldosterone secretion<ref name="Goodman, Fuller" /><ref name="Kumar, Abbas" /><ref name="Goodman, Snyder" /> | ||
* Severe abdominal, low back, or leg pain<ref name="Goodman, Fuller" /> | * Severe abdominal, low back, or leg pain<ref name="Goodman, Fuller" /> | ||
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== Associated Co-Morbidities == | == Associated Co-Morbidities == | ||
Addison's disease can occur alone, or it can occur along with other autoimmune disorders, leading to polyendocrine syndrome<ref name=":2">NHS | Addison's disease can occur alone, or it can occur along with other autoimmune disorders, leading to polyendocrine syndrome<ref name=":2">NHS. Addison's disease:Causes. Available at https://www.nhs.uk/conditions/addisons-disease/causes/ (Accessed 13 July 2020)</ref>. | ||
*[[Diabetes Mellitus Type 1|Type I Diabetes Mellitus]] | *[[Diabetes Mellitus Type 1|Type I Diabetes Mellitus]] | ||
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*Vitiligo (a loss of pigment on areas of the skin) | *Vitiligo (a loss of pigment on areas of the skin) | ||
*Chronic Active [[Hepatitis A, B, C|Hepatitis]] | *Chronic Active [[Hepatitis A, B, C|Hepatitis]] | ||
[[Osteoporosis|Osteoporosis]] is more common among people with Addison's disease compared to healthy individuals because of the medical management with long-term steroid replacement therapy. Steroids have several effects on bones including increasing osteoclastic activity, decreasing osteoblastic formation, and decreasing the absorption of calcium in the intestines.<ref name="Adachi">Compston J | [[Osteoporosis|Osteoporosis]] is more common among people with Addison's disease compared to healthy individuals because of the medical management with long-term steroid replacement therapy. Steroids have several effects on bones including increasing osteoclastic activity, decreasing osteoblastic formation, and decreasing the absorption of calcium in the intestines.<ref name="Adachi">Compston J. Glucocorticoid-induced osteoporosis: an update. ''Endocrine.'' 2018;''61''(1), 7–16. https://doi.org/10.1007/s12020-018-1588-2 Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5997116/ (Accessed 13 July 2020) </ref> | ||
<br>'''Bone Mineral Density T-Scores<ref name="Goodman, Snyder" /> ''' | <br>'''Bone Mineral Density T-Scores<ref name="Goodman, Snyder" /> ''' | ||
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== Diagnostic Tests/Lab Tests/Lab Values == | == Diagnostic Tests/Lab Tests/Lab Values == | ||
*Adrenocorticotropic Hormone (ACTH) Stimulation Test: This is the most common test performed in diagnosing Addison's disease. Blood cortisol and/or urine cortisol levels are measured following being administered with a synthetic form of ACTH. Normally cortisol levels will increase following the administration of the synthetic ACTH. However, patients with Addison's disease experience little or no increase in cortisol levels following the test.<ref name="NIDDK">U.S. National Library of Medicine | *Adrenocorticotropic Hormone (ACTH) Stimulation Test: This is the most common test performed in diagnosing Addison's disease. Blood cortisol and/or urine cortisol levels are measured following being administered with a synthetic form of ACTH. Normally cortisol levels will increase following the administration of the synthetic ACTH. However, patients with Addison's disease experience little or no increase in cortisol levels following the test.<ref name="NIDDK">U.S. National Library of Medicine. ACTH stimulation test. Available at https://medlineplus.gov/ency/article/003696.htm (Accessed 13 July 2020)</ref> Diagnostically significant levels are elevated ACTH levels (≥ 50 pg/mL) with low cortisol levels (< 5 μg/dL [< 138 nmol/L]).<ref name="Merck" /> | ||
*Corticotropin-Releasing Hormone (CRH) Stimulation Test: This test is performed when there are abnormal results from the ACTH test. In this test, blood cortisol levels are measured 30, 60, 90, and 120 minutes following an intravenous injection of synthetic CRH. Patients with Addison’s disease will have increased levels of ACTH but no cortisol.<ref name="NIDDK" /> | *Corticotropin-Releasing Hormone (CRH) Stimulation Test: This test is performed when there are abnormal results from the ACTH test. In this test, blood cortisol levels are measured 30, 60, 90, and 120 minutes following an intravenous injection of synthetic CRH. Patients with Addison’s disease will have increased levels of ACTH but no cortisol.<ref name="NIDDK" /> | ||
*X-ray or ultrasound of the abdomen may be performed following laboratory tests to determine if calcium deposits exist in the adrenal glands.<ref name=":2" /><br> | *X-ray or ultrasound of the abdomen may be performed following laboratory tests to determine if calcium deposits exist in the adrenal glands.<ref name=":2" /><br> | ||
'''Test Results That Suggest Addison's Disease<ref name="Merck">Grossman A. Addison's Disease. The Merck Manuals Online Medical Library. Available at: http://merck.com/mmpe/sec12/ch153/ch153b.html Accessed 16 | '''Test Results That Suggest Addison's Disease<ref name="Merck">Grossman A. Addison's Disease. The Merck Manuals Online Medical Library. Available at: http://merck.com/mmpe/sec12/ch153/ch153b.html (Accessed 16 July 2020)</ref>''' | ||
{| width="400" cellspacing="1" cellpadding="1" border="1" | {| width="400" cellspacing="1" cellpadding="1" border="1" | ||
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== Causes == | == Causes == | ||
There are a number of causes for Addison’s disease, the most common causes are autoimmune adrenalitis, infectious adrenalitis from disease such as [[tuberculosis]], the [[HIV | There are a number of causes for Addison’s disease, the most common causes are autoimmune adrenalitis, infectious adrenalitis from disease such as [[tuberculosis]], the [[Human Immunodeficiency Virus (HIV)|acquired immune deficiency syndrome (AIDS)]], syphilis or adrenal metastases such as lung, stomach, breast or colon cancer.<ref>Nicolaides N. Chrousos G. and Charmandari E. South Dartmouth (MA): MDText.com. Inc.; 2000-. Available at https://www.ncbi.nlm.nih.gov/books/NBK279083/ (Accessed 16 July 2020)</ref> About 70% of cases in the US and UK are due to idiopathic atrophy of the adrenal cortex, probably caused by autoimmune processes<ref name="Merck" /><ref name=":2" /> | ||
== Adrenal Crisis == | == Adrenal Crisis == | ||
| Line 192: | Line 189: | ||
== Differential Diagnosis == | == Differential Diagnosis == | ||
*Ingestion of Heavy Metals<ref name="Merck" />: Excessive ingestion of heavy metals (such as arsenic poisoning) may lead to hyperpigmentation that is also seen with Addison's disease. | *Ingestion of [[Heavy Metal Poisoning|Heavy Metals]]<ref name="Merck" />: Excessive ingestion of heavy metals (such as arsenic poisoning) may lead to hyperpigmentation that is also seen with Addison's disease. | ||
*Hemochromatosis<ref name="Merck" />: This is the most common form of iron overload. One of the common signs of this disorder is abnormal pigmentation of the skin, appearing grey or bronze. | *Hemochromatosis<ref name="Merck" />: This is the most common form of iron overload. One of the common signs of this disorder is abnormal pigmentation of the skin, appearing grey or bronze. | ||
*Peutz-Jeghers syndrome<ref name="Merck" />: This inherited disorder is also characterised by melanin spots in the oral mucosa, the lips, and the digits. However, along with this disease, patients develop polyps in the gastrointestinal system leading to abdominal cramping and blood in the stool, which are not all found in Addison's disease. | *Peutz-Jeghers syndrome<ref name="Merck" />: This inherited disorder is also characterised by melanin spots in the oral mucosa, the lips, and the digits. However, along with this disease, patients develop polyps in the gastrointestinal system leading to abdominal cramping and blood in the stool, which are not all found in Addison's disease.<ref name="Eisner">Eisner T. Peutz-Jeghers Syndrome. Medline Plus. 2009. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000244.htm (Accessed 26 July 2020)</ref> | ||
*[[Hypothyroidism|Hypothyroidism]]<ref name="emedicine">Liotta EA. Addison Disease: Differential Diagnoses Workup. emedicine | *[[Hypothyroidism|Hypothyroidism]]<ref name="emedicine">Liotta EA. Addison Disease: Differential Diagnoses Workup. emedicine. Available at: http://emedicine.medscape.com/article/1096911-diagnosis.</ref>: This refers to a deficiency of the thyroid hormone leading to a generalized decrease in metabolism. One of the most common signs of this disorder is the feeling of fatigue and sluggishness. However, it is common that people with this disorder experience weight gain, while patients with Addison's disease will lose weight due to the vomiting and anorexia.<ref name="Hypothyroidism">MayoClinic. Hypothyroidism. Available at: http://www.mayoclinic.com/health/hypothyroidism/DS00353/DSECTION=symptoms</ref> | ||
*Hypopituitarism: This results from decreased hormone production by the anterior pituitary gland. Since ACTH is a primary hormone of the anterior pituitary, it is not released, thus decreasing the stimulation of the adrenals to release cortisol. Since there is a similar decrease in cortisol, this disorder has many of the common symptoms of Addison's disease, such as hypoglycemia, anorexia, nausea, and lethargy.<ref name="Goodman, Fuller" /> | *Hypopituitarism: This results from decreased hormone production by the anterior pituitary gland. Since ACTH is a primary hormone of the anterior pituitary, it is not released, thus decreasing the stimulation of the adrenals to release cortisol. Since there is a similar decrease in cortisol, this disorder has many of the common symptoms of Addison's disease, such as hypoglycemia, anorexia, nausea, and lethargy.<ref name="Goodman, Fuller" /> | ||
Latest revision as of 13:16, 6 January 2022
Original Editors - Elizabeth Bohnert from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Top Contributors - Elizabeth Bohnert, Admin, Natalie Patterson, Kim Jackson, Laura Ritchie, Elaine Lonnemann, Tony Lowe, WikiSysop, 127.0.0.1, Wendy Walker, Claire Knott and Lucinda hampton
Addison's Disease[edit | edit source]
Addison’s disease is another name for primary chronic adrenal insufficiency. It is a condition where the adrenal cortex (the outer layer of the adrenal gland that produces mineralocorticoids, glucocorticoids, and androgens) is progressively destroyed, resulting in decreased secretions of hormones.[1][2] Cortisol, a glucocorticoid, and aldosterone, a mineralocorticoid, are the hormones that are affected by Addision's disease causing a global metabolic disorders and fluid imbalance.[1]In the developed world, Addison's disease is most commonly caused by autoimmune disease however worldwide, tuberculosis is the most common cause.
Adrenal insufficiency may also be caused by long-term administration of corticosteroids or disorders of the hypothalamus or pituitary gland, but this is not Addison's disease.[3]
Clinically Relevant Anatomy[edit | edit source]
The adrenal (suprarenal) glands are endocrine glands that are located superior to the kidneys. The adrenal glands have two layers the adrenal cortex (the outer layer) that is responsible for producing steroid hormones and the inner layer the medulla which is responsible for secreting the hormones that control our stress response, commonly referred to as our fight or flight response[4]
The Adrenal Cortex[edit | edit source]
The adrenal cortex is the outer layer of the gland and is divided into three zones:
- Zona glomerulosa is where mineralocoticoids are produced. They help to control blood pressure and electrolyte balance ie aldosterone
- Zona Fasciculata this is where the glucocorticoids are produced. They help to regulate the metabolism and control the body’s response to stress i.e. cortisol and cortisone such as cortisol
- Zona Reticularis this is where androgens are converted into functional sex hormones (tortora)
Total loss of the steroid hormones secreted by the outer layer results in death due to dehydration and electrolyte imbalance. Unless corrected by hormone replacdement therapy death will usually occur within weeks, sometimes within a few days.[4]
The Adrenal Medulla[edit | edit source]
The inner zone of the adrenal glands are responsible for producing catecholamine. These are hormones such as epinephrine (adrenaline) and norepinephrine (noradrenaline) and small amounts of dopamine whose function is to initiate a rapid response to stressful situations.[4]
Prevalence[edit | edit source]
Addison’s disease occurs in about 1 in 100,000 Americans[5]. About 8,400 people are currently diagnosed with Addison's disease in the UK[3]. Even though it is seen throughout the lifespan in both genders, it most commonly occurs in middle-aged white females.
Characteristics/Clinical Presentation[edit | edit source]
Addison’s disease will develop insidiously, with the signs of the disease not developing “until at least 90% of both glands is destroyed and the levels of circulating glucocorticoids and mineralocorticoids are significantly decreased.”[2] Some of the clinical signs and symptoms of Addison’s disease include:
- Darkened pigmentation of the skin (especially of the mouth and scars), due to increased secretion of melanin-secreting hormone (MSH) corresponding with increased secretion of ACTH, which is released to try to stimulate the work of the adrenal glands[1][2]
- Slowly developing weakness and fatigue[2][6]
- Hypotension due to increased sodium excretion from decreased aldosterone secretion[1][2][6]
- Severe abdominal, low back, or leg pain[1]
- Gastrointestinal disturbances - such as nausea, vomiting, anorexia, weight loss, and diarrhoea[2][6]
- Hypoglycemia due to decreased glucocorticoids causing decreased gluconeogenesis[1][2]
- Decreased stress tolerance (infections, trauma, surgery, etc.)[1][2]
- Salt craving
- Hypovolaemic shock,
- Low-grade fever
- Vomiting
- a sudden crisis precipitated by intercurrent infection or stress.
Addison's disease should also be considered in a person with persistent, non-specific symptoms, such as:
- fatigue
- hyperpigmentation
- gastrointestinal symptoms
- cravings for salt
- musculoskeletal symptoms
- postural dizziness due to hypotension.[3]
The possibility of Addison's disease should also be considered in people with:
- hypothyroidism whose symptoms worsen when thyroxine is started
- type 1 diabetes mellitus with recurrent unexplained hypoglycaemic episodes
- other autoimmune diseases
- or low sodium and high potassium levels on blood biochemistry.
Associated Co-Morbidities[edit | edit source]
Addison's disease can occur alone, or it can occur along with other autoimmune disorders, leading to polyendocrine syndrome[7].
- Type I Diabetes Mellitus
- Hypoparathyroidism
- Thyroiditis
- Pernicious Anemia
- Vitiligo (a loss of pigment on areas of the skin)
- Chronic Active Hepatitis
Osteoporosis is more common among people with Addison's disease compared to healthy individuals because of the medical management with long-term steroid replacement therapy. Steroids have several effects on bones including increasing osteoclastic activity, decreasing osteoblastic formation, and decreasing the absorption of calcium in the intestines.[8]
Bone Mineral Density T-Scores[6]
| Status | T-Scores |
| Normal | -1.0 or above |
| Osteopenia | -1.0 to -2.5 |
| Osteoporosis | -2.5 or less |
| Severe Osteoporosis | -2.5 or less with 1 or more fragility fractures |
Medications[edit | edit source]
- Hydrocortisone is usually used for glucocorticoid replacement, but longer-acting glucocorticoids, such as prednisolone and dexamethasone, are sometimes used to avoid the peaks and troughs which may occur with hydrocortisone.
- Fludrocortisone is usually used for mineralocorticoid replacement.
- Dehydroepiandrosterone (unlicensed) may be prescribed by some specialists for androgen replacement.[3]
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
- Adrenocorticotropic Hormone (ACTH) Stimulation Test: This is the most common test performed in diagnosing Addison's disease. Blood cortisol and/or urine cortisol levels are measured following being administered with a synthetic form of ACTH. Normally cortisol levels will increase following the administration of the synthetic ACTH. However, patients with Addison's disease experience little or no increase in cortisol levels following the test.[9] Diagnostically significant levels are elevated ACTH levels (≥ 50 pg/mL) with low cortisol levels (< 5 μg/dL [< 138 nmol/L]).[10]
- Corticotropin-Releasing Hormone (CRH) Stimulation Test: This test is performed when there are abnormal results from the ACTH test. In this test, blood cortisol levels are measured 30, 60, 90, and 120 minutes following an intravenous injection of synthetic CRH. Patients with Addison’s disease will have increased levels of ACTH but no cortisol.[9]
- X-ray or ultrasound of the abdomen may be performed following laboratory tests to determine if calcium deposits exist in the adrenal glands.[7]
Test Results That Suggest Addison's Disease[10]
| Test | Result |
| Blood Chemistry | |
| Serum Na | < 135 mEq/L |
| Serum K | > 5 mEq/L |
| Ratio of Serum Na:K | <30:1 |
| Plasma Glucose, fasting | < 50 mg/dL |
| Plasma HCO3 | < 15-20 mEq/L |
| BUN | > 20 mg/dL |
| Hematology | |
| Hct | Elevated |
| WBC Count | Low |
| Lymphocytes | Relative lymphocytes |
| Eosinophils | Increased |
| Imaging | |
|
Evidence of calcification in adrenal areas Renal TB Pulmonary TB |
[Chart courtesy of Merck.com. Available at http://merck.com/mmpe/sec12/ch153/ch153b.html]
Causes[edit | edit source]
There are a number of causes for Addison’s disease, the most common causes are autoimmune adrenalitis, infectious adrenalitis from disease such as tuberculosis, the acquired immune deficiency syndrome (AIDS), syphilis or adrenal metastases such as lung, stomach, breast or colon cancer.[11] About 70% of cases in the US and UK are due to idiopathic atrophy of the adrenal cortex, probably caused by autoimmune processes[10][7]
Adrenal Crisis[edit | edit source]
Adrenal Crisis is rare but should not be overlooked. When in crisis, the patient with Addison's disease the adrenal glands gradually stop producing enough cortisol to supply the body. Cortisol is involved with many body systems and this condition can result in threat to life.
Signs of Adrenal Crisis include:
- Dehydration,
- Nausea and vomiting,
- Abdominal pain,
- Anorexia and chills.
If left untreated, symptoms of shock, fever and convulsions may follow. An adrenal crisis is a medical emergency.[7]
Physical Therapy Management[edit | edit source]
There is very little information and research pertaining to the physical therapy management of patients with Addison's disease. Jakobi et al[12] found that women with Addison's disease had a similar maximum voluntary force of the quadriceps muscle compared to the control group of healthy individuals, however, they had "altered contractile properties and decreased endurance compared with controls." Obviously, more research needs to be performed to determine the proper interventions that physical therapists should utilize to treat patient's with Addison's disease and also determine any limitations to treating these patients.
Therapist are equipped in helping people to overcome some of their symptoms prior to diagnosis to allow them to return to all levels of activities, such as:
- Slowly developing weakness and fatigue[2][6]
- Severe abdominal, low back, or leg pain[1]
- Fatigue
- Musculoskeletal symptoms
Differential Diagnosis[edit | edit source]
- Ingestion of Heavy Metals[10]: Excessive ingestion of heavy metals (such as arsenic poisoning) may lead to hyperpigmentation that is also seen with Addison's disease.
- Hemochromatosis[10]: This is the most common form of iron overload. One of the common signs of this disorder is abnormal pigmentation of the skin, appearing grey or bronze.
- Peutz-Jeghers syndrome[10]: This inherited disorder is also characterised by melanin spots in the oral mucosa, the lips, and the digits. However, along with this disease, patients develop polyps in the gastrointestinal system leading to abdominal cramping and blood in the stool, which are not all found in Addison's disease.[13]
- Hypothyroidism[14]: This refers to a deficiency of the thyroid hormone leading to a generalized decrease in metabolism. One of the most common signs of this disorder is the feeling of fatigue and sluggishness. However, it is common that people with this disorder experience weight gain, while patients with Addison's disease will lose weight due to the vomiting and anorexia.[15]
- Hypopituitarism: This results from decreased hormone production by the anterior pituitary gland. Since ACTH is a primary hormone of the anterior pituitary, it is not released, thus decreasing the stimulation of the adrenals to release cortisol. Since there is a similar decrease in cortisol, this disorder has many of the common symptoms of Addison's disease, such as hypoglycemia, anorexia, nausea, and lethargy.[1]
Resources[edit | edit source]
National Endocrine and Metabolic Diseases Information Service
Addison's Disease Self-Help Group
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Goodman CC, Fuller KS. Pathology: Implications for the Physical Therapist. St. Louis: Elsevier; 2009.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Kumar V, Abbas AK, Fausto N. Pathologic Basis of Disease. Philadelphia: Elsevier; 2005.
- ↑ 3.0 3.1 3.2 3.3 NICE. Addison's disease. Available at:https://cks.nice.org.uk/addisons-disease#!topicSummary (Accessed 29 June 2020)
- ↑ 4.0 4.1 4.2 The Johns Hopkins Hospital, and Johns Hopkins Health System. Adrenal Glands. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/adrenal-glands#:~:text=Adrenal%20glands%2C%20also%20known%20as,stress%20and%20other%20essential%20functions. (Accessed 29 June 2020)
- ↑ NORD. Addison’s Disease. Available at https://rarediseases.org/rare-diseases/addisons-disease/ (Accessed 29 June 2020)
- ↑ 6.0 6.1 6.2 6.3 6.4 NHS. Bone density scan (DEXA scan). Available at https://www.nhs.uk/conditions/dexa-scan/what-happens/ (Accessed 29 June 2020)
- ↑ 7.0 7.1 7.2 7.3 NHS. Addison's disease:Causes. Available at https://www.nhs.uk/conditions/addisons-disease/causes/ (Accessed 13 July 2020)
- ↑ Compston J. Glucocorticoid-induced osteoporosis: an update. Endocrine. 2018;61(1), 7–16. https://doi.org/10.1007/s12020-018-1588-2 Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5997116/ (Accessed 13 July 2020)
- ↑ 9.0 9.1 U.S. National Library of Medicine. ACTH stimulation test. Available at https://medlineplus.gov/ency/article/003696.htm (Accessed 13 July 2020)
- ↑ 10.0 10.1 10.2 10.3 10.4 10.5 Grossman A. Addison's Disease. The Merck Manuals Online Medical Library. Available at: http://merck.com/mmpe/sec12/ch153/ch153b.html (Accessed 16 July 2020)
- ↑ Nicolaides N. Chrousos G. and Charmandari E. South Dartmouth (MA): MDText.com. Inc.; 2000-. Available at https://www.ncbi.nlm.nih.gov/books/NBK279083/ (Accessed 16 July 2020)
- ↑ Jakobi J, Killinger D, Wolfe B, Mahon J, Rice C. Quadriceps muscle function and fatigue in women with Addison's disease. Muscle Nerve. August 2001;24(8):1040-1049.
- ↑ Eisner T. Peutz-Jeghers Syndrome. Medline Plus. 2009. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000244.htm (Accessed 26 July 2020)
- ↑ Liotta EA. Addison Disease: Differential Diagnoses Workup. emedicine. Available at: http://emedicine.medscape.com/article/1096911-diagnosis.
- ↑ MayoClinic. Hypothyroidism. Available at: http://www.mayoclinic.com/health/hypothyroidism/DS00353/DSECTION=symptoms
