Are you always tired? Is your skin turning black? Let's learn about Addison's Disease!

Do you feel tired all the time, feel lifeless, and your skin color is gradually changing? Maybe you have a strange craving for salt. We often ignore such symptoms as normal. However, these can be signs of a disease inside our body that is not so common, but it is very important to identify it correctly. Today we are talking about such a rare disease, but if managed properly, you can live a normal life. That is Addison's Disease .

Simply put, what is Addison's Disease?

Okay, let's explain this simply. We have two small, triangular-shaped glands, like a hat, above our kidneys. We call these the adrenal glands . These are a very important part of our endocrine system.

Addison's disease is a condition in which the adrenal glands do not produce enough of two essential hormones, cortisol and aldosterone .

What do we need these two hormones for?

• Cortisol: This is a hormone that is essential for life. It helps our bodies cope with stress, such as when we are sick, have an accident, or undergo surgery. It also helps regulate blood pressure, heart rate, immune system function, and blood glucose levels.

• Aldosterone: This hormone helps balance the minerals sodium (salt) and potassium in our bodies. It also controls how much fluid our kidneys excrete as urine. This also directly affects our blood pressure.

Addison's disease is also known as primary adrenal insufficiency . There is another related condition, called secondary adrenal insufficiency . In this condition, the pituitary gland in the brain does not release enough of the hormone ACTH , which stimulates the adrenal glands to produce cortisol. But today we are mainly talking about the problem that occurs in the adrenal glands themselves.

Difference between Addison's disease and Cushing's syndrome

You might be confused by these two names. These two are completely opposite situations.

Who is most likely to get this disease? How common is it?

Although Addison's disease can affect people of any age, it is most common in people between the ages of 30 and 50 .

This is actually a very rare condition . For example, in America, this disease affects about one in a hundred thousand people. But there are people with this disease in our country too.

There are people who are at higher risk of developing this disease. Those are people who have other autoimmune diseases . That is, diseases in which our body's own immune system attacks our own cells. If we have such diseases, the risk of developing Addison's disease is higher.

• Type I diabetes
• Pernicious anemia
• Graves' disease
• Chronic thyroiditis
• Vitiligo - white patches on the skin
• Myasthenia gravis

What are the symptoms of Addison's disease?

In Addison's disease, damage to the adrenal glands often occurs very slowly, over time. Therefore, symptoms appear gradually. These symptoms can vary from person to person.

Women may also experience symptoms such as irregular menstruation, body hair loss, and decreased sexual desire.

Symptoms of an Addisonian crisis:

• An unbearable, extraordinary weakness.
• Sudden, severe pain in the lower back, abdomen, or legs.
• Mental changes such as restlessness, confusion, and feelings of fear.
• Severe vomiting and diarrhea (this can lead to rapid dehydration).
• Blood pressure dropping too low.
• Loss of consciousness.

If you or someone you know experiences these symptoms, immediately take them to the nearest hospital's Emergency Department (ETU).

What are the causes of Addison's disease?

The main and most common cause of Addison's disease is an autoimmune response . Simply put, our body's own defense system (the immune system) mistakenly attacks and destroys the outer part of our own adrenal glands (the adrenal cortex). The exact reason why this happens is not yet known. Symptoms begin to appear after about 90% of these glands have been destroyed. This can take months, or even years.

This is the cause of 75% of Addison's patients.

Other rare causes:

• Tuberculosis: This was a major cause in the past. It is still a significant cause in developing countries.
• Recurrent infections: Infections related to HIV/AIDS and fungal infections.
• Cancer: Spread of cancer cells from elsewhere to the adrenal glands.
• Hemorrhage into the adrenal glands.
• Surgical removal of the adrenal glands.
• Amyloidosis: A disease in which a type of protein accumulates in organs and damages them.

How to diagnose this disease? (Diagnosis)

Because the symptoms come on very slowly and are common to many other diseases, Addison's disease can be difficult to diagnose in the early stages. Often, the disease is discovered "incidentally." Doctors may suspect this if they find low sodium levels and high potassium levels in the blood during a routine blood test for another condition. Also, hyperpigmentation of the skin is a major symptom that leads to suspicion of this disease.

If your doctor suspects this based on your symptoms, they will order several more tests to confirm the disease.

Diagnostic tests:

• Blood tests: Blood tests measure the levels of sodium, potassium, cortisol, and ACTH hormones. In Addison's disease, cortisol is low and ACTH levels are high.
• ACTH stimulation test: This is the main test used to confirm the diagnosis. In this test, the synthetic ACTH hormone is given as an injection, and the cortisol level in your blood is measured about an hour later. If your adrenal glands are healthy, your cortisol level should increase. However, if it does not, it confirms that your adrenal glands are not functioning properly.
• Insulin-induced hypoglycemia test: This test is done to find out if your symptoms are caused by a problem with the pituitary gland.
• CT scan: A CT scan may be done to check if your adrenal glands are damaged, infected, or have shrunken in size.

How is it treated?

The primary method of treating Addison's disease is to replace the deficient hormones in the body in the form of synthetic pills (Hormone Replacement Therapy) .

• A drug called hydrocortisone is given instead of the hormone cortisol .
• A drug called fludrocortisone is given instead of the hormone aldosterone .

The dose of these medications varies from person to person. Also, your doctor may temporarily increase your dose to prevent an Addisonian crisis if you experience a stressful event, such as an infection, accident, or surgery.

If you are taking fludrocortisone, your doctor will advise you to add a little extra salt to your diet, especially during hot, sweaty weather and after strenuous exercise.

Living with the disease and what you should do

With proper treatment, someone with Addison's disease can live a completely normal, healthy life . However, it is very important to maintain the correct dosage of medication.

If the dosage of the medication is too high, side effects such as obesity, type 2 diabetes, osteoporosis, and high blood pressure can occur. Therefore, it is essential to regularly see your doctor (often an endocrinologist) and undergo the necessary tests to maintain the correct dosage of the medication.

Things you should do for your own safety:

• Always wear an ID card or a medical alert bracelet/necklace. This will help medical staff know that you have Addison's disease if you lose consciousness in an emergency.
• Talk to your doctor about keeping a cortisol shot on hand in case of an emergency. Also, teach a family member or loved one how to give the shot to you.
• Ask your doctor what to do when you feel sick or are under a lot of stress. In such cases, the dosage of your medication may need to be adjusted.
• Continue to see your doctor.

Knowing you have a chronic condition can be emotionally distressing. But the good news is that Addison's disease is very well-controlled with medication. The most important thing is to stay in regular contact with your doctor and get the treatment you need.

Addison's Disease, adrenal glands, cortisol, aldosterone, autoimmune, skin darkening, chronic fatigue, hormones, hydrocortisone, fludrocortisone, adrenal insufficiency