Addison's disease is a rare disorder This occurs because the body lacks hormones that should be produced by the adrenal glands. Addison's disease can affect anyone, but it is more common in women aged 30–50 years.
Addison's disease occurs when the adrenal glands are damaged, so they cannot produce sufficient amounts of a group of steroid hormones, including the hormones cortisol and aldosterone. Cortisol and aldosterone hormones have an important role for the body.
The hormone cortisol functions to maintain blood pressure, heart function, immune system, and blood sugar levels. Meanwhile, the hormone aldosterone functions to help the kidneys regulate the amount of salt and water in the body.
Generally, symptoms that arise early in the development of the disease tend to be mild. However, as the damage to the adrenal glands gets worse, symptoms can be severe and even life-threatening.
Causes and Risk Factors for Addison's Disease
The adrenal glands consist of two parts, namely the outer (cortex) and the inner (medulla). The adrenal cortex is responsible for producing a group of steroid hormones, including the hormones cortisol and aldosterone.
In Addison's disease, the adrenal cortex is damaged, so the hormones cortisol and aldosterone cannot be produced in sufficient quantities. Some conditions that can cause damage to the adrenal gland cortex are:
- Autoimmune disease
- Injury or bleeding of the adrenal glands
- Cancer that spreads from other organs to the adrenal glands
- Amyloidosis
- Genetic disorders
- Surgery on the adrenal glands
Although it can be experienced by anyone, Addison's disease is more at risk for someone with the following factors:
- Female, aged 30–50 years
- Taking medication to treat Cushing's syndrome
- Have another autoimmune disease, such as type 1 diabetes or vitiligo
- Suffering from a long-lasting infection, such as tuberculosis (TB) or HIV/AIDS
- Suffering from pernicious anemia, for example due to vitamin B12 deficiency
- Suffering from cancer
- Taking anticoagulants, corticosteroids, or antifungal drugs
- Have a family history of Addison's disease
Conditions related to Addison's disease (Secondary Adrenal Insufficiency)
There are several diseases that can cause symptoms like Addison's disease but are not caused by damage to the adrenal glands. This condition is called secondary adrenal insufficiency, while Addison's disease is called primary adrenal insufficiency.
Secondary adrenal insufficiency results from a decrease in adrenocorticotropic hormone (adrenocorticotropic hormone; ACTH) is a hormone that stimulates the adrenal glands. This condition is usually caused by an abnormality in the pituitary gland.
In addition, secondary adrenal insufficiency can also be triggered by sudden discontinuation of long-term corticosteroid therapy, for example in people with chronic diseases, such as asthma or asthma. arthritis.
Symptoms of Addison's Disease
In the early stages, the symptoms of Addison's disease are difficult to detect because they are similar to the symptoms of other diseases, such as:
- Tired and lack of enthusiasm
- Stomach pain
- Excessive desire to eat salty food
- Drowsiness
- Nausea or vomiting
- Diarrhea
- Sluggish
- No appetite, resulting in weight loss
- Low blood sugar (hypoglycemia)
- Headache
- Dizziness when standing
- Darkening of body folds (hyperpigmentation)
- Muscle pain and cramps
- Easily angry
- Frequent urination
- Often thirsty
- Difficult to concentrate
- Hair loss
- Irregular menstruation
- Delayed puberty in children
- Loss of sexual desire
- Depression
When the damage to the adrenal glands is severe, it can cause severe symptoms. Sometimes, severe symptoms can appear suddenly, without any previous mild symptoms. This condition is called an Addison's crisis or adrenal crisis and can be life threatening.
The following are signs and symptoms of an adrenal crisis:
- Body feels very weak
- Pain in the lower back or legs
- Severe stomach ache
- Vomiting and diarrhea that is severe and leads to dehydration
- Very low blood pressure (shock)
- Confusion
- Loss of consciousness
When to go to the doctor
Symptoms of Addison's disease are not typical, so sufferers often do not realize that the complaints they are experiencing are symptoms of this disease. Therefore, do a self-examination to the doctor if you experience the above symptoms, especially if there are symptoms such as:
- Hyperpigmentation
- Severe fatigue
- Drastic weight loss
- Digestive disorders, such as diarrhea
- Muscle or joint pain
- Dizzy
- Faint
Immediately go to the emergency room or the nearest doctor if you experience symptoms of Addison's crisis. If you are around a person who has decreased consciousness, call an ambulance immediately or take him to the ER.
Addison's Disease Diagnosis
To diagnose Addison's disease, initially the doctor will ask questions about the patient's symptoms, medical history, and medical history. After that, the doctor will perform a thorough physical examination, including a blood pressure check and a skin condition check to look for hyperpigmentation.
The doctor will also perform investigations to confirm the diagnosis and find out the cause of Addison's disease. Some of the supporting tests that can be done are:
blood test
This test is done to determine the levels of sugar, sodium, potassium, cortisol, aldosterone, and adrenocorticotropic hormone (ACTH) in the blood. Blood tests are also done to detect antibodies that can attack the adrenal glands.
ACTH stimulation test
ACTH stimulation test is performed to determine the level of the hormone cortisol in the blood before and after synthetic ACTH is injected. In Addison's disease, the hormone cortisol will remain low after injection of synthetic ACTH.
Scan
The scan can be done with a CT scan or MRI, to detect abnormal size of the adrenal glands, abnormalities in the pituitary gland, and determine the cause of adrenal insufficiency.
Addison's Disease Treatment
Addison's disease can be treated with therapy that aims to replace the amount of steroid hormones that are reduced and cannot be produced by the body, including:
- Giving kOrticosteroid tabletsDrugs used to replace the hormone cortisol are prednisone or methylprednisolone. Meanwhile, fludrocortisone is used to replace aldosterone.
- Giving kinjectable orticosteroidsInjectable corticosteroid drugs are usually given to patients who experience vomiting symptoms and cannot take corticosteroid tablets.
In addition, the conditions underlying the occurrence of adrenal gland damage also need to be addressed. For example, giving antibiotics for at least 6 months, if damage to the adrenal glands is caused by tuberculosis.
During the treatment period, patients will be advised to have regular check-ups every 6 months or once a year so that the doctor can monitor the progress of the condition. Patients also need to consult a doctor to adjust the dose of the drug if:
- Having an infection, which is characterized by a high fever
- Having an accident, such as a car accident
- Having surgery, such as dental surgery, dental fillings, or endoscopy
- Doing sports or strenuous activities
Addison's Disease Complications
A complication of Addison's disease is an adrenal crisis. These complications can occur if:
- Addison's disease is not diagnosed or treated immediately
- Patient discontinues self-medication
- Patients do not adjust drug doses when experiencing physical stress, injury, or infection
Adrenal crisis is an emergency condition that requires immediate medical attention. The reason is, this crisis can lead to coma, permanent brain damage, and death if handled too late.
Addison's Disease Prevention
Addison's disease cannot be prevented. Therefore, if you feel the symptoms, immediately consult a doctor, especially if you also have risk factors for Addison's disease. Early detection and treatment can delay disease progression and prevent complications.