Addison's Disease, Causes, Signs and Symptoms, Diagnosis and Treatment.

Addison's disease, also known as primary adrenal insufficiency,[4] is a rare long-term endocrine disorder characterized by inadequate production of the steroid hormones cortisol and aldosterone by the two outer layers of the cells of the adrenal glands (adrenal cortex), causing adrenal insufficiency.[5] Symptoms generally come on slowly and insidiously and may include abdominal pain and gastrointestinal abnormalities, weakness, and weight loss.[1] Darkening of the skin in certain areas may also occur.[1] Under certain circumstances, an adrenal crisis may occur with low blood pressure, vomiting, lower back pain, and loss of consciousness.[1] Mood changes may also occur. Rapid onset of symptoms indicates acute adrenal failure which is a serious and emergent condition.[5] An adrenal crisis can be triggered by stress, such as from an injury, surgery, or infection.[1]

Addison's disease arises from problems with the adrenal gland such that not enough of the steroid hormone cortisol and possibly aldosterone are produced.[1] In developed countries, the etiology of Addison's disease is often attributed to idiopathic damage by the body's own immune system, and in developing countries most often due to tuberculosis.[6][needs update] Other causes include certain medications, sepsis, and bleeding into both adrenal glands.[1][6] Secondary adrenal insufficiency is caused by not enough adrenocorticotropic hormone (ACTH) (produced by the pituitary gland) or corticotropin-releasing hormone (CRH) (produced by the hypothalamus).[1] Despite this distinction, adrenal crises can happen in all forms of adrenal insufficiency.[1] Addison's disease is generally diagnosed by blood tests, urine tests, and medical imaging.[1]

Addison's disease can be described in association with chronic mucocutaneous candidiasis, acquired hypoparathyroidism, diabetes mellitus, pernicious anemia, hypogonadism, chronic and active hepatitis, malabsorption, immunoglobulin abnormalities, alopecia, vitiligo, spontaneous myxedema, Graves' disease, and chronic lymphocytic thyroiditis.[7]

Treatment involves replacing the absent hormones.[1] This involves taking a synthetic corticosteroid, such as hydrocortisone or fludrocortisone.[1][2] These medications are usually taken by mouth.[1] Lifelong, continuous steroid replacement therapy is required, with regular follow-up treatment and monitoring for other health problems.[8] A high-salt diet may also be useful in some people.[1] If symptoms worsen, an injection of corticosteroid is recommended and people should carry a dose with them.[1] Often, large amounts of intravenous fluids with the sugar dextrose are also required.[1] Without treatment, an adrenal crisis can result in death.[1]

Addison's disease affects about 0.9 to 1.4 per 10,000 people in the developed world.[1][3] It occurs most frequently in middle-aged females.[1] Secondary adrenal insufficiency is more prevalent.[3] Long-term outcomes with treatment are typically favorable.[9] It is named after Thomas Addison, a graduate of the University of Edinburgh Medical School, who first described the condition in 1855.[10] The adjective "addisonian" is used to describe features of the condition, as well as people with Addison's disease.[11]
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