identifying an Addisonian crisis

Addison’s disease is a rare autoimmune disease in which the body is unable to produce two vital hormones: cortisol and aldosterone. Patients with this disease will need hormone replacement therapy for life. Learn more about this rare disorder with Dr Rasha Mukhtar, a consultant in diabetes and endocrinology, who gives us a quick overview of the symptoms and treatments and what an adrenal crisis looks like.

What is Addison’s disease?

In the medical world Addison’s disease, also known as primary adrenal insufficiency, is the name given when the adrenal glands do not produce enough steroid hormones. The lack of steroids is caused when the adrenal cortex is targeted and destroyed by the body’s own immune system.

Many use the name for any condition which results in the lack of steroid production from the adrenal gland. These include pituitary dysfunction, adrenal haemorrhage, excessive use of exogenous steroids, or destruction of the adrenal gland via infection. Although these are treated in a similar manner, they are not caused by the same process.

Addison's disease is an autoimmune process and can present independently or alongside other autoimmune diseases such as thyroid problems, diabetes, vitiligo, and some forms of arthritis.

What are the symptoms?

Symptoms can be vague and present slowly over a period of time. They include:

• fatigue
• abdominal pain
• weight loss
• feeling light-headed due to low blood pressure
• muscle or joint pains
• craving salt
• hyperpigmentation

Those newly presenting with Addison’s can appear more tanned and therefore look much healthier than they are or feel. In situations of severe stress, individuals may present acutely ill with what is known as an adrenal crisis. Symptoms of this include severe abdominal pain, vomiting and diarrhoea, weakness, confusion and reduced consciousness. These symptoms can be life-threatening if not recognised and treated urgently.

How is Addison’s disease treated?

Treatment is through replacing the deficient hormones. The essential hormone to replace is cortisol which is usually given in the form of hydrocortisone, two or three times a day, to mimic the body’s natural steroid production cycle.

Patients with Addison’s will usually need mineralocorticoid replacement in the form of fludrocortisone to help maintain blood pressure.

Can Addison’s disease be cured?

Curing Addison’s disease is not yet possible, although there is research ongoing to see if early intervention with immunomodulating drugs can help stop the further destruction of the gland and promote recovery.

Taking the correct steroid replacement therapy does allow an individual to live a normal life without restrictions but they do need to be aware of what precautions to take to avoid an Addisonian crisis. This information should be supplied by your doctor in the form of a guide known as ‘sick-day rules’ to help you adjust and manage your medication when you’re feeling unwell.

Some individuals will be concerned that taking steroids for Addison’s will have adverse events but it is important to remember that the doses used are small and are to replace what the body would normally produce.

Can lifestyle choices help manage the condition?

Although a healthy lifestyle is recommended for all individuals, this will not prevent or treat Addison’s disease. It is important to remember if you have adrenal insufficiency then you must take your steroid medication at all times.

If you believe you are suffering from any symptoms mentioned in this article and would like to see Dr Rasha Mukhtar, visit her Top Doctors profile and check her availability.