Addison's Disease

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Definition/Description

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 the hormones.  Cortisol, a glucocorticoid, and aldosterone, a mineralcorticoid, are the primary hormones that are decreased with this disease, causing body wide metabolic disorders and fluid imbalances.

Prevalence

Addison’s disease occurs in about 4 out of 100,000 Americans each year.  Even though it is seen throughout the lifespan in both genders, it most commonly occurs in middle-aged white females.

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.”2  Some of the clinical signs and symptoms of Addison’s disease include:

• Darkened pigmentation of the skin, 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 glands1,2, 

• Slowly developing weakness and fatigue2,3

• Hypotension due to increased sodium excretion from decreased aldosterone secretion1,2,3

• Severe abdominal, low back, or leg pain1

• Gastrointestinal disturbances such as nausea, vomiting, anorexia, weight loss, and diarrhea2,3

• Hypoglycemia due to decreased glucocorticoids causing decreased gluconeogenesis1,2

• Decreased stress tolerance (infections, trauma, surgery, etc.)1,2

• Salt craving

 

Associated Co-morbidities

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Medications

Acute Therapy :

• Intravenously administered hydrocortisone (100 mg), repeated every 6 hours for the first 24 hours

• Intravenously administered rapid infusion of saline (2-4L) during the first 12 hours

Maintenance Therapy4:

• Glucocorticoid Replacement: 15-20 mg of hydrocortisone daily, divided into 3 or 4 doses to simulate normal adrenal secretions

• Mineralocorticoid Replacement: 0.05-0.1 mg of fludrocortisones daily

Diagnostic Tests/Lab Tests/Lab Values

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Causes

There are a number of causes for Addison’s disease, however “90% of all cases are attributable to one of four diseases: autoimmune adrenalitis, tuberculosis, the acquired immune deficiency syndrome (AIDS), or metastatic cancers.”2  The primary sites of the metastases to the adrenal glands usually arise from carcinomas of the lungs or breasts.2

Systemic Involvement

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Medical Management (current best evidence)

Refer to Medications.

Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports

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Resources

National Adrenal Diseases Foundation

The Mayo Clinic

Recent Related Research (from Pubmed)

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References

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