# Addison's Disease --- **Addison's disease**, sometimes called **primary adrenal insufficiency** is a relatively uncommon [[disease]] that affects the [[adrenal glands]] and causes them to not produce enough [[glucocorticoids|cortisol]] and [[renin-angiotensin-aldosterone system|aldosterone]]. >[!person] >US president JFK suffered from Addison's disease, among other ailments ## Causes 80-90% of causes are [[autoimmune disorder|autoimmune]] (specifically a [[type IV hypersensitivity|type 4 hypersensitivity]]) or idiopathic atrophy of the [[adrenal glands]]. The remaining times it's from a surgical removal of the glands themselves, presumably to treat some other disease such as malignancy. Symptoms of adrenal insufficiency may also arise when [[corticosteroids|steroid therapy]] is stopped suddenly, and the body hasn't had time to ramp up it's own hormone production (see [[#Addisonian Crisis]] below). This is why it's always important to educate patients to wean down steroid use. ## Signs & Symptoms The signs and symptoms of Addison's disease [[glucocorticoids|cortisol]] maintains energy and blood glucose levels, and responds to stress as well as regulates cardiovascular functions; [[renin-angiotensin-aldosterone system|aldosterone]] regulates sodium and, by extension water and potassium levels. - cortisol - fatigue - irritability/depression - weight loss - glucose - salt craving/[[hyponatremia]] - [[hypoglycemia]] - aldosterone - [[hyponatremia]] - [[hyperkalemia]] - N/V - hyperpigmentation - muscle/joint/abdominal pain ## Addisonian Crisis An **Addisonian crisis** is an extreme exacerbation of Addison's symptoms. It can be precipitated by stress, overexertion, low salt intake, or dehydration leading to circulatory collapse, shock and death if not treated. An Addisonian crisis manifests with things such as: - profound fatigue - signs of [[shock]] - hypotension, cyanosis, etc. - fever - N/V Treatment for an Addisonian Crisis: - laying with legs up - IV fluids - D5 or normal saline - vasopressin if hypotension persists - antibiotics if infection precipitated the crisis ## Diagnostic Tests The diagnostic tests for Addison's include checking the blood for things like - Cortisol (will be low) - this should be taken early in the morning - [[adrenocorticotropic hormone|ACTH]] (will be high) - hypoaldosteronism leads to a production of ACTH, but no ALDO is ever produced - electrolytes (sodium/potassium imbalance) - WBC (leukocytes will be elevated) ## Treatment There is no cure for Addison's disease, but it is treatable with (lifelong) [[hormone replacement therapy]]. Patients with Addison’s disease require a high protein, high carbohydrate, high sodium, low potassium diet. ___