Addison’s disease

Definition, Causes, and Epidemiology of Addison’s Disease
– Addison’s disease is a rare endocrine disorder characterized by inadequate production of cortisol and aldosterone by the adrenal glands.
– It can be caused by autoimmune problems, tuberculosis, certain medications, sepsis, and bleeding into the adrenal glands.
– The disease is generally diagnosed through blood tests, urine tests, and medical imaging.
– Addison’s disease affects about 9 to 14 per 100,000 people in the developed world.
– Frequency rate of Addison’s disease in the human population is estimated at one in 100,000.
– The number of cases per million population is 40-144 cases (1/25,000-1/7,000).
– Addison’s disease can affect persons of any age, sex, or ethnicity.
– The typical age of onset is adults between 30 and 50 years of age.
– There are no significant predispositions based on ethnicity.
– Addison’s disease was named after Thomas Addison, the British physician who first described it in 1855.
– Tuberculosis used to be a major cause of Addison’s disease worldwide.
– US president John F. Kennedy suffered from complications of Addison’s Disease throughout his life.
– Hypoadrenocorticism is uncommon in dogs and rare in cats.

Symptoms and Diagnosis of Addison’s Disease
– Symptoms of Addison’s disease develop slowly and may include abdominal pain, weakness, weight loss, and darkening of the skin.
– An adrenal crisis, characterized by low blood pressure, vomiting, lower back pain, and loss of consciousness, can occur.
– Mood changes may also occur, and rapid onset of symptoms indicates acute adrenal failure.
– Gastrointestinal symptoms such as nausea, abdominal pain, and vomiting are common.
– Blood tests often reveal low blood sodium, high blood potassium, and high thyroid-stimulating hormone (TSH).
– Routine laboratory investigations may show low blood sugar, low blood sodium, high blood potassium, eosinophilia, and lymphocytosis.
– Metabolic acidosis can occur due to loss of hormone aldosterone.
– Cortisol and aldosterone levels are tested to diagnose Addison’s disease.
– ACTH stimulation test is performed to assess adrenal hormone levels after synthetic pituitary ACTH hormone administration.
– Adrenoleukodystrophy should be considered in males with idiopathic Addison’s disease, and a blood test can detect very long-chain fatty acids.

Treatment and Complications of Addison’s Disease
– Treatment for Addison’s disease involves replacing the absent hormones, typically through synthetic corticosteroids like hydrocortisone or fludrocortisone.
– These medications are usually taken orally, and lifelong, continuous steroid replacement therapy is required.
– Regular follow-up treatment and monitoring for other health problems are necessary.
– A high-salt diet may be useful for some individuals.
– Injections of corticosteroids and intravenous fluids with dextrose may be required in case of symptom worsening or adrenal crisis.
– Without treatment, an adrenal crisis can be life-threatening.
– Most people with Addison’s disease develop or have a preexisting autoimmune disease.
– Common comorbid conditions include autoimmune thyroid disease, premature ovarian failure, type 1 diabetes, pernicious anemia, vitiligo, and celiac disease.
– The combination of Addison’s disease with mucocutaneous candidiasis, hypoparathyroidism, or both is called autoimmune polyendocrine syndrome type 1.
– The presence of Addison’s disease with autoimmune thyroid disease, type 1 diabetes, or both is called autoimmune polyendocrine syndrome type 2.

Adrenal Crisis in Addison’s Disease
– An adrenal crisis is a severe adrenal insufficiency requiring immediate emergency treatment.
– It can be caused by undiagnosed Addison’s disease, sudden adrenal function impairment, or intercurrent problems like infection or trauma.
– Loss of cortisol and aldosterone production in the adrenal glands leads to the slow onset of disease symptoms.
– Cortisol loss affects energy metabolism, stress responses, and other bodily processes, while aldosterone loss affects electrolyte balance and blood pressure.
– Destruction of the adrenal glands also disrupts the secretion of androgens, resulting in sexual function dysregulation.

Other Animals and Treatment of Hypoadrenocorticism
– Hypoadrenocorticism is rare in cats, with less than 40 known cases worldwide since first documented in 1983.
– Individual cases of hypoadrenocorticism have been reported in a grey seal, a red panda, a flying fox, and a sloth.
– Hypoadrenocorticism is diagnosed in many dog breeds, and female dogs appear to be more affected than male dogs.
– Treatment of hypoadrenocorticism involves replacing the hormones (cortisol and aldosterone) that the dog cannot produce.
– Treatment options include daily treatment with fludrocortisone or monthly injections with desoxycorticosterone pivalate (DOCP) and daily treatment with a glucocorticoid.
– Follow-up blood tests are required to adjust the dose of medication.
– Increased dose of prednisone may be necessary in anticipation of stressful situations.
– Lifelong treatment is required, but the prognosis for dogs with hypoadrenocorticism is very good.https://en.wikipedia.org/wiki/Addison%27s_disease