Addison's disease also known as chronic adrenal insufficiency is a hormonal disorder characterized by tissue necrosis and granulomatous appearance. Addison's disease occurs to people irrespective of age and gender. Addison's disease is also known as hypocortisolism as it is associated with insufficient production of cortisol from the adrenal glands.
Cortisol belongs to the class of glucocorticoid hormones. They are released from the cortex of the adrenal glands located on top of the kidneys. Cortisol has a significant function in the body and is associated with main organ system functions in maintaining the homeostasis in the body. Cortisol is essential in protein, carbohydrate and fat metabolism. It also helps in the regulation and release of insulin for blood sugar balance.
The other important functions of cortisol include maintenance of blood pressure, cardiovascular activity and inflammatory response process associated with the immune system. The level of cortisol in the body is used as a determination of stress management. Cortisol has precursors for its release such as the adrenocorticotropic hormone released due to the stimulus associated with the hypothalamus and pituitary gland.
Addison's disease etiology is predominantly based upon the function of the adrenal gland and the release of cortisol regulated by the pituitary gland. Insufficient cortisol production may be due to impairment of adrenal glands which is categorized as the primary phase in Addison's disease occurrence. The secondary factors are associated with release of adrenocorticotropic hormone levels from the pituitary gland to stimulate the adrenal gland. The tertiary factors are associated with insufficient release of corticotrophin releasing hormone from the hypothalamus.
Significant clinical manifestations include anorexia, vomiting, hypoglycemia, weight loss, cutaneous and mucosal pigmentation, hypernatremia, hyperkalemia, hypotension caused due to extra cellular fluid loss. Excess melanin production is observed along with visible changes in the surfaces of lips and buccal mucosa. Addison's disease can also occur because of preexisting factors such as tuberculosis, histoplasmosis, coccidioiodomycosis , autoimmune diseases and conditions associated with bilateral metastases, hemorrhages, amyloidosis and adrenoleukodystrophy.
Diagnosis of Addison's disease
Addison's disease is diagnosed by clinical symptoms which are correlated with biochemical laboratory tests. The levels of sodium, potassium and other important parameters with respect to inflammatory response and hormonal levels can diagnose the presence of Addison's disease. One of the significant diagnostic tools used to detect the presence of Addison's disease is the ACTH (adrenocorticotropic hormone stimulation test). In this test, ACTH is given intravenously to the patient and the levels of cortisol in urine and blood are examined. This test determines adrenal insufficiency factor.
Addison's disease and pregnancy
Steroid hormone balance and support aids labor and fetal development. Insufficiency of steroid hormones can affect the pregnancy especially during a cesarian. Conditions associated with Addison's disease may increase under situations of emergency. This is because of lack of steroid production in the body. Symptoms such as colds, confusion, increased weakness and fatigue can occur; which may become fatal if untreated.
Diet for Addison's disease
Patients with Addison's disease express cravings for salty food or foods that have citrus flavor. Sufficient intake of proteins balanced with vitamins and minerals is advisable. Many patients suffer dehydration; hence increased fluid intake is advised. Diet patterns can be altered in patients having conditions such as diabetes, hypertension and osteoporosis.
Treatment for Addison's disease
Hydrocortisone and fludrocortisone are generally used to replace the cortisol and aldosterone hormones in cases of adrenal insufficiency. Other options used are prednisone, dexamethasone with slow and sustained release characteristics. The advisable dosage for these steroid hormones is thrice a day to meet with the energy demands and activity of the individual.
Hyperpigmentation is a condition where parts of the skin turn darker in color than surrounding areas. These dark patches are generally seen on the face, hands, shoulders, or the neck area of an individual. These spots are usually referred to as liver spots, solar lentigines, pregnancy mask or freckles. Some kinds of hyperpigmentation spots could turn cancerous if not treated appropriately. A dermatologist could help distinguish hyper pigmentation from regular tanning or sunburn and provide effective treatment.
Hyper pigmentation causes
Melanocytes present in the skin's epidermis produce melanin which is the pigment responsible for the color of skin, eye and hair of an individual. Hormonal, physical changes or environmental factors trigger melanocytes to produce excessive melanin. This imbalance in production also affects the melanocyte's ability to distribute melanin evenly across the skin's epidermis. Therefore the excess melanin usually forms clusters and the skin tends to appear darker in the melanin concentrated areas, leading to uneven skin tone and darker areas.
Hormonal changes occurring during pregnancy and menopause can trigger excess melanin production. Diseases like hypothyroidism and Addison's disease can set off melanocyte stimulating hormones. Excessive sun exposure can play havoc on melanin production. Some medications such as those for insomnia, infertility, hypertension and oral contraceptives can cause hyperpigmentation.
Creams containing Hydroquinone, alpha Hydroxyl acid, licorice, green tea extracts or Retinol are prescribed for topical application. Chemical peels and skin dermabrasion are done to improve the skin tone. Laser procedures can work on melanin pigments.
Melanin is responsible for imparting color to the skin, hair and iris of the eyes. Levels of melanin depend on race and amount of sunlight exposure. Melanin production increases with exposure to the skin so as to protect the skin against harmful ultraviolet rays. Skin pigmentation disorders occur as a result of the body producing either too much or too little melanin. Skin pigmentation creates a darker or lighter skin tone that may be blotchy and uneven. Sun damage is probably the leading cause of skin pigmentation problems. Other factors include drug reactions, hormonal changes, genetic factors and medications.
Hormonal therapy, childbirth or birth control pills can cause skin pigmentation changes. Many people suffer from skin pigmentation problems as a result of locally increased skin pigment production. They appear as age spots, moles, liver spots or hyper pigmentation after local skin damage. Freckles are another variation in pigmentation of the skin. They are caused but by uneven release of the pigment.
Hypopigmentation or loss of skin pigmentation is a condition where the body does not produce sufficient melanin. Sometimes after an ulcer, blister, burn, or infection heals, the skin loses some of its pigment in that area. Albino is one who suffers total hypopigmentation at birth.
Vitiligo: Vitiligo is another form of hypo pigmentation caused by the loss of pigment-producing cells in the skin (melanocytes). These white patches are very sensitive to the sun. This skin pigmentation disorder affects nearly 2% of the population and is more evident in those with darker skin. Some scientists believe vitiligo may be caused by an autoimmune disorder. It is also linked to hyperthyroidism and Addison's Disease that affects the adrenal glands.
Hyper Pigmentation is a condition where the body produces too much melanin thereby causing it to become darker than usual. Hyper pigmentation can occur due to excessive sun bathing or drug reactions. Many a time wounds and scars leave a darker patch of skin. Birthmarks, moles, and aging spots are also indications of hyper pigmentation. It is important to keep on the alert for any change in size, color or texture for indications of skin cancer.
Lichen Simplex Chronicus: This skin pigmentation disorder is characterized by dark patches of skin accompanied with severe itching. This can lead to permanent scarring and infection if untreated.
Melasma: This hyper pigmentation condition is a fallout of pregnancy hormones. A dark mask appears over the cheeks, bridge of the nose and the neck. This skin pigmentation condition is also known as chloasma and can be treated with prescription creams and over-the-counter products.
Birthmarks: This type of skin pigmentation appears at birth or in the few weeks following birth. These birthmarks do not generally pose any health risks.
Port-wine Stains: These skin pigmentation spots are caused by abnormal development of capillaries and appear as a red or purple mark on the body.
Bibliography / Reference
Collection of Pages - Last revised Date: February 19, 2019