How To Recognize, Diagnose and Treat Addison's Disease

While there are other types of adrenal insufficiency that fall under the category of "Addison's disease", the most common type is autoimmune adrenalitis. This article helps us to have better general understanding of this disease.

1. Addison’s disease is an autoimmune disease affecting the adrenal glands. Each person has two adrenal glands, which are glands of the endocrine system sitting on top of each kidney in a person’s body. These glands are small and shaped like pyramids about the size of a walnut, measuring about 3 x 5 x 1 cm in size. The immune system can mistakenly recognized these glands as intruders and begin to attack them (autoimmune response), slowly destroying them with antibodies (killer cells from the immune system). This causes the glands to become inadequate in supplying the important adrenal hormones needed by the body, the two major hormones being cortisol and DHEA. Symptoms of Addison’s disease appear once the adrenal cortex (the protective outer layer of the gland) has been destroyed by the autoimmune process known as autoimmune adrenalitis.
2. The symptoms of Addison’s disease are those of adrenal insufficiency. Addison’s disease causes adrenal insufficiency, meaning a reduction in adrenal hormone production and output. The two major hormones that become low due to this are cortisol and DHEA.
   • Cortisol is the “stress hormone” and “anti-inflammatory hormone” that gives the body its ability to handle and recover from stressors and inflammation.
   • DHEA is a “sex hormone precursor”, meaning the hormone that converts into testosterone, estrogen and other hormones needed by the body.

   When the adrenal hormones become low, a person may experience fatigue, joint/muscle pain, weight loss and diminished appetite, low blood pressure and hyper-pigmentation (darkening of the skin). If left untreated, people with Addison’s disease are at risk of experiencing an adrenal crisis, meaning they will go into shock and possibly coma or death.

3. Addison’s disease is most often diagnosed through blood testing and MRI. Medical blood lab testing can measure the adrenal hormone levels and if they are found to be low, this can indicate adrenal insufficiency due to Addison’s disease.

   Patients will then usually be tested for adrenal function via an ACTH Stimulation Test. This test uses the ACTH hormone, which usually comes from a person’s own pituitary gland, to stimulate adrenal-cortisol hormone production but, during the test, is administered to the patient by injection. A patient will have a baseline blood draw taken before the test. After the ACTH hormone injection, they will have two or more additional blood draws taken at 30 minute intervals, and these three blood levels will then be compared. If the two or more additional blood levels of cortisol do not significantly increase above the baseline level, a diagnosis of adrenal insufficiency is confirmed.
   Other tests that may be ordered would include an MRI to detect the extent of adrenal gland destruction, and a blood test to detect antibodies that the immune system is directing against the adrenal glands.
4. Addison’s disease is treated by replacing the low adrenal hormone levels. Once blood tests reveal which adrenal hormones are low, hormone replacement therapy will begin. One of the major hormones called cortisol, which is most commonly low in adrenal insufficiency states, must be replaced with a steroid cortisol substitute called a “glucocorticoid steroid” or a "corticosteroid". Patients will need replacement with this synthetic hormone for the rest of their lives.

   Addison’s disease patients are also usually required to wear a medical ID bracelet, so that if they experience an adrenal crisis, the person finding them will know that they are treated for Addison’s disease and that they may need to have an injection of corticosteroid steroid administered.

There are other causes of adrenal insufficiency, but Addison’s disease is the most common, affecting about 1 in 100,000 people according to medical sources.