American Medical Association Family Medical Guide - American Medical Association [614]
Addison’s Disease
Addison’s disease is a potentially life-threatening condition in which the outer layer of the adrenal glands (the adrenal cortex) gradually slows production of corticosteroid hormones. The disease usually occurs when the adrenal cortex is damaged or destroyed as a result of an autoimmune disorder, in which the immune system mistakenly attacks the adrenal glands. In rare cases, tuberculosis (see page 663) can cause Addison’s disease. Addison’s disease can sometimes run in families and can be the first sign of a rare inherited disorder called adrenoleukodystrophy.
Symptoms
The symptoms of Addison’s disease—including loss of appetite, weight loss, dizziness, fatigue, weakness, muscle aches, and anemia (see page 610)—usually develop gradually. Other symptoms can include mild indigestion, nausea and vomiting, diarrhea, or constipation. In some cases, the skin may darken noticeably and permanently. Some people become more sensitive to cool temperatures.
If Addison’s disease is left untreated, symptoms of acute adrenal failure (such as severe abdominal pain or dizziness) may develop and the person may go into shock (see page 162). Undergoing surgery or having an injury or a severe infection or other illness can trigger this life-threatening condition. During a medical examination of a person with acute adrenal failure, a doctor will find that the person has low blood pressure and kidney failure.
WARNING!
Acute Adrenal Failure
Acute adrenal failure is a medical emergency that requires immediate medical treatment. If you are with someone who has Addison’s disease or another disorder of the adrenal glands and he or she has symptoms of acute adrenal failure (such as severe abdominal pain or dizziness) or if he or she goes into shock, call 911 or your local emergency number, or take the person to the nearest hospital emergency department immediately.
Diagnosis
A diagnosis of Addison’s disease is based on the symptoms and a physical examination. The doctor will recommend blood and urine tests to measure the levels of corticosteroid hormones and to evaluate kidney function. He or she also may recommend a blood test to look for antibodies (proteins the body may have mistakenly produced to attack the adrenal glands). The presence of antiadrenal antibodies indicates an autoimmune response.
Treatment
To treat Addison’s disease, your doctor will prescribe oral corticosteroid medication to replace the corticosteroid hormones your body is not producing. (Doctors may prescribe intravenous corticosteroids for people who are extremely ill.) You will probably need to take these drugs for the rest of your life.
Your doctor will give you a medical identification card that indicates you have Addison’s disease. Always carry this card with you so emergency medical personnel will know what treatment to provide in case of an emergency. Whenever you have an illness or infection, call your doctor as soon as possible. He or she may increase your dose of corticosteroids to prevent acute adrenal failure. If you are planning to have surgery, make sure the surgeon knows that you have Addison’s disease. Most people who are treated for Addison’s disease are able to lead healthy, active lives.
Aldosteronism
Aldosteronism is a rare disorder in which the cortex of the adrenal glands produces too much of the hormone aldosterone, which results in high blood pressure (see page 574). Aldosteronism can result from a tumor in one adrenal gland (called Conn’s syndrome) or from an enlargement of both adrenal glands. The disorder also can be caused by an underlying disease or condition that reduces blood flow through the kidneys, such as congestive heart failure (see page 570).
Symptoms and Diagnosis
The symptoms of aldosteronism include elevated blood pressure, fatigue, tingling, muscle weakness, muscle spasms, and paralysis. Some people also may experience increased thirst and frequent