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Understanding Addison’s Disease: Adrenal Insuffiency

Dr Ben Ng Addison's Disease

Addison’s disease, also referred to as primary adrenal insufficiency, is a relatively rare condition where the adrenal glands fail to produce adequate amounts of steroid hormones. 

The disease can have profound implications, but patients can lead a normal life with timely diagnosis and proper management. Medical Channel Asia invites Dr Ben Ng, Consultant Endocrinologist at Arden Endocrinology Specialist Clinic Mount Elizabeth Novena, to provide key insights to this condition.

Understanding the Adrenal Glands

Before delving into the disease, it’s essential to comprehend the function of the adrenal glands. These two small glands located on top of each kidney are responsible for producing several vital hormones, including cortisol and aldosterone.

  • Cortisol plays a significant role in regulating metabolism, reducing inflammation, and helping the body respond to stress.
  • Aldosterone helps control blood pressure by managing salt and water balance.

Causes of Addison’s Disease

The most common cause of Addison’s disease in developed countries is an autoimmune reaction, wherein the body’s immune system attacks the adrenal glands. Other causes can include:

  • Tuberculosis
  • Certain infections
  • Bleeding into the adrenal glands
  • Surgical removal of the adrenal glands

Dr Ben Ng, Director of Arden Endocrinology Specialist Clinic Mount Elizabeth Novena shared, “The most common cause why people develop Addison’s disease is autoimmune disease. In autoimmune disease, the individual develops antibodies that attack certain body parts. For Addison’s disease, in particular, individuals develop antibodies that attack and subsequently destroy the adrenal gland, causing the body to lose its ability to produce important hormones such as cortisol and aldosterone. Also known as primary adrenal insufficiency, this has to be differentiated from secondary adrenal insufficiency, where in the latter condition, the body loses its ability to produce steroids, mainly due to long-term usage of steroid medication.”

Symptoms and Signs

Addison’s disease can be a gradual onset, with symptoms intensifying over time. Common signs include:

  • Chronic fatigue and muscle weakness
  • Loss of appetite and weight loss
  • Darkened skin patches (hyperpigmentation)
  • Low blood pressure
  • Salt cravings due to salt loss
  • Low blood sugar (hypoglycemia)
  • Nausea, diarrhoea or vomiting
  • Irritability and depression

Diagnosis and Treatment

A timely diagnosis is crucial for Addison’s disease. Blood tests can measure sodium, potassium, cortisol, and adrenocorticotropic hormone (ACTH) levels to confirm the diagnosis. An ACTH stimulation test can also measure how well the adrenal glands respond to the ACTH hormone.

Once diagnosed, the primary treatment involves hormone replacement therapy to replace the insufficient hormones. Regular doctor visits will ensure the correct dosage and monitor potential side effects.

Dr Ng added, “Diagnosing Addison’s disease can be challenging, especially in the early stages. Individuals who develop this condition will experience low blood pressure, extreme fatigue, weight loss, joint pains and depression. General and commonly used blood tests, such as low cortisol, low salt or high potassium, can explain the diagnosis. However, the goal standard for diagnosis is called a short synacthen test, a specific test to evaluate adrenal function.”

Living with Addison’s Disease

While the diagnosis can be overwhelming, with consistent treatment and regular medical check-ups, individuals with Addison’s can lead a whole and active life. However, it’s crucial to:

  • Take medications consistently as prescribed
  • Regularly monitor blood pressure and blood sugar
  • Wear a medical alert bracelet, informing healthcare providers of the condition in emergencies
  • Have an emergency injection kit, especially during illnesses or stressful events

How does the management of Addison’s Disease change during times of stress or illness for the patient?

Dr Ng shared that “Cortisol, also known as the distress hormone, gets elevated at any time of stress. In individuals with normal adrenal function, cortisol levels rise in response to stress or illness and help to maintain blood pressure, temperature, immunity and blood sugar levels. Individuals with Addison’s disease will need higher doses of steroid replacement as their body is unable to produce adequate amounts to respond to the stress or insult in the body.”

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