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Writing surrounds: Paul Margulies, M.D., F.A.C.P., F.A.C.E.
Medical Director - NADF
Clinical associate professor of the medicine, medical university of the university of Cornell
The disease of Addison is a severe or total deficiency of hormones done in the suprarrenal crust, caused by a destruction of the suprarrenal crust. There are normally two suprarrenales glands, located on each kidney. The suprarrenales glands are really two glands of the endocrina (endocrina or hormone producing) in one. The internal part of the suprarrenal (called the marrow) produces epinephrine (also call adrenalin) that occasionally takes place of the tension and aid to the body to respond to the situations of the "fight or the flight" raising to the pulse, fitting flow of the blood, and raising the blood sugar. Nevertheless, the absence of the suprarrenal marrow and epinephrine noncause disease.
In resistance, the external portion of the suprarrenal, the crust, is more critical. The suprarrenal crust makes two hormones, cortisol and aldosterones important steroids. Cortisol mobilizes foods, modifies the answer of the body to the inflammation, it stimulates the liver to raise the blood sugar, and also aid to control the amount of water in the body. The aldosterone regulates levels of the salt and the water that affects the volume of the blood and the arterial pressure. The production of cortisol is regulated by another hormone, hormone adrenocorticotrophic (HORMONE ADRENOCORTICOTRÓFICA), done in the pituitaria gland that is located hardly underneath the brain. The disease of classic Addison is from a loss of cortisol and secretion of the aldosterone due to near the total or total destruction of both suprarrenales glands. This condition also is called primary suprarrenal shortage. If HORMONE ADRENOCORTICOTRÓFICA is deficient, there will be no enough produced cortisol, although the aldosterone can continue being adapted. This is the suprarrenal shortage, that is differently different, but similar secondary to the disease of Addison, since both include a loss of secretion of cortisol.
When the Dr Thomas Addison's first described this disease in London in 1855, the cause commonest was tuberculosis. This one continued being the main cause until the center of the twentieth century in which the antibiotics reduced the TB incidence progressively. Since then, the main cause of the disease of Addison is from a reaction autoinmune in which the immune system of the body erroneously makes the antibodies against the cells of the suprarrenal crust and it destroys them slowly. That process has been to months the years. There are also several less common causes of the disease of Addison: other chronic infections in addition to the tuberculosis, specially certain fungicidas infections, invasion of the suprarrenal by the cells of cancer that are had separated of another part of the body, specially the chest; Virus CMV in the association with the AIDS; rarely, hemorrhage in the glands suprarrenals during shock; and the surgical retirement of both glands suprarrenals.
There is no exact statistic on the incidence of the disease of Addison in the United States. A study in London demonstrated cases of thirty-nine by million populations in date 1960. Twelve were due to the tuberculosis. In the group of the not-tuberculosis, the women were three times more probable to have disease of Addison. The extrapolation from these figures to the United States would give near 8,800 cases, but this is probably an underestimation.
The slowly progressive loss of secretion of cortisol and the aldosterone produces a chronic one generally, constantly making worse fatigue, a loss of appetite, and a certain loss of the weight. The arterial pressure is low and low more far when a person is being stopped, producing I am annoying. Nausea, sometimes with vomiting, and the diarrea is common. The muscles are weak and often enter espasmo. There are often emotional changes, particularly irritability and depression. Due to loss of the salt, yearning for for salty foods is common. Finally, the increase in HORMONES ADRENOCORTICOTRÓFICAS due to the loss of cortisol will produce generally to grow dark of the skin that can seem a so inadequate one in a person who feels very ill. Unfortunately, slowly progressive the chronic symptoms are lacked generally or not paid attention until a sudden event like a virus to the influenza, an accident, or the necessity of the surgery suddenly precipitates a dramatic change for worse due to the deficient answer of the glands suprarrenals to one of these tensions. This talks about as crisis of Addisonian and is a medical emergency.
A medical file of the mentioned symptoms above, specially hyperpigmentation of the skin or rubbers, is often enough to raise a strong mistrust, urging the appropriate tests. Absolutely often, nevertheless, the first track is of the abnormal results of the routine tests made in a hospital or the office of the doctor. These can include an elevated level of the blood of potassium, a level under the blood of sodium, a change in the quotient of certain white cells of blood, or the changes that surprise in a EKG x-ray or of the chest that is caused by high potassium or the volume under the blood. Other causes for these changes, particularly of medications, are due to consider first. A definitive diagnosis of the disease of Addison requires that the definitive tests are made. These tests measure the amount of cortisol and of aldosterone in the blood and it tinkles, and document it a deficiency of the normal increase in the levels of these two hormones after the administration of HORMONES ADRENOCORTICOTRÓFICAS given by the injection. An elevated level of the HORMONE blood ADRENOCORTICOTRÓFICAS must also be found. If the patient is very ill and the disease suspicion of Addison, the treatment can be initiated whereas the tests are becoming of diagnosis. Once the diagnosis of the disease of Addison settles down, a effort is due to make to find the cause by the verification to know if there are tuberculosis and other infections through tests and of x-rays of the skin.
Since all the manifestations of the disease of Addison are caused by the deficiency of cortisol and the aldosterone, the treatment is to replace these by similar steroids. Cortisol is replaced generally oral by the tablets of divided acetate or hidrocortisona of the cortisone in dose in the morning and of afternoon. The aldosterone is replaced by aldosterone-like the synthetic steroid, tablets of fludrocortisone (Florinef) given once daily. The doses of each one of these medications adjust according to any medical condition of coexistence of the individual the size and. In emergencies or during surgery, hidrocortisona is due to give intravenous. The patients with the disease of Addison must be taught to deal with diseases smaller importance with the additional salt and liquids. This is specially important if the fever, vomiting or the diarrea are present. The persistence of these samples requires the immediate treatment in an intravenous quarter of saline emergency with (salt water) and hidrocortisona. Since the disease of Addison is a chronic condition, the daily medication of the replacement can never be stopped.
The appropriate treatment of the maintenance requires regular visits to a doctor for the examinaciones, the laboratory tests, and the discussions on symptoms. Certain analyses of blood, including sodium, the potassium, accounts of blood and renin of the plasma are very useful in the supervision of the answer to the adjustments in the metering. There is no blood or analysis of tinkles that he is perfect by itself.
Endocrinologists is specialistic in hormonal diseases, including the disease of Addison. Due to the peculiarity of the disease, endocrinologist will correctly have more training and experience in the disease of Addison that it diagnoses and that treats that most of the doctors.
The secondary suprarrenal shortage, caused by a HORMONE deficiency ADRENOCORTICOTRÓFICAS, gives rise to a deficiency of cortisol, but generally not of the aldosterone. The cause is pituitaria disease, as a tumor, or the prolonged use of the medication "steroid" that suppresses HORMONES ADRENOCORTICOTRÓFICAS. The treatment is simply to replace cortisol, generally by prednisone synthetic steroid, but sometimes the acetate of hidrocortisona or the cortisone.
The disease of Addison autoinmune, the type commonest, can be associated to other diseases autoinmunes that affect other glands of endocrina similar. Commonest it is the thyroid. If a thyroid underactive (hipotiroidismo) coexists with the disease of Addison, this is called the syndrome of Schmidt. The diseases autoinmunes less commonly associated are mellitus insulin-employee of the diabetes, and shortages of the glands, the gónadas ones, and the absorption paratiroides of the B12 vitamin (pernicious anemia).
While the appropriate dose of the medication of the replacement takes every day, a Addisonian can have a normal crisis-free life. There are specific physical or no occupational restrictions. The routine care includes regular visits of the doctor, the avoidance of the dehydration, and the use of the additional medication during disease. The pregnancy is possible, but it will require the supervision of the supplement of the medication of the replacement. Each Addisonian must use a bracelet or a necklace of the identification that it indicates that it or it has the disease, to assure the appropriate treatment the emergency. An identification card that also skirts the treatment suggests. Today, people with the disease of Addison must have a normal life expectancy.
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