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Addisons disease or Primary Adrenal Insufficiency is relatively rare, occurs most often in adults 30 to 60 years of age. It is characterized by inadequate corticosteroid and mineralocorticoid synthesis and elevated serum ACTH levels. The most common cause of Addisons disease in the United States is autoimmune destruction of the adrenal cortex, more common in women. Other causes include tuberculosis of the adrenal gland, familial adrenal insufficiency, amyloidosis, and adrenal hemorrhage. (McCance & Huether, 2018) Adrenal failure in Addison disease results in decreased cortisol production initially followed by that of aldosterone, both of which will eventually cause elevated adrenocorticotropic hormone (ACTH) and plasma renin levels in the blood through the loss of negative feedback inhibition. (Munir & Waseem, 2020)
Hyponatremia is the most common initial laboratory finding and can be attributed to low cortisol and aldosterone levels. Loss of aldosterone activity leads to natriuresis and potassium retention, thus further confounding electrolyte abnormalities, including life-threatening hyperkalemia. (Munir & Waseem, 2020) The clinical manifestations of Addisons disease are primarily a result of hypercortisolism and hypoaldosteronism. Weakness and easy fatigability, skin changes, including hyperpigmentation and vitiligo may occur. As the condition progresses, anorexia, nausea and vomiting and diarrhea develop. Symptoms of mineralocorticoid deficiency include hypovolemia, postural hypotension, and dizziness, dehydration, hyperkalemia, and salt-craving. The development of hypotension can progress to complete vascular collapse and shock. This is known as the adrenal crisis or Addisonian crisis. An Addisonian crisis is a medical emergency. If it is not treated, it can lead to shock and death. (McCance & Huether, 2018) As Addison’s crisis is life-threatening, treatment should be initiated immediately when the diagnosis is suspected. Patients with adrenal crisis require the following, fluid resuscitation with intravenous (IV) normal saline (to correct volume depletion), dextrose (to correct hypoglycemia), and hormone replacement to correct a lack of circulating glucocorticoid (Munir & Waseem, 2020)
It is important to educate the patient regarding the warning signs of adrenal crisis. They include severe nausea and vomiting, diarrhea, abdominal pain, dehydration and confusion, hypotension, and fainting. Patients with Addison’s will need hormone replacement therapy for life. High doses of corticosteroids are linked to a higher risk of osteoporosisa condition in which the bones become less dense and more likely to fracture. If you take corticosteroids, you may need to protect your bone health by getting enough dietary calcium and vitamin D. All patients diagnosed with Addison disease must be urged to wear a medical alert bracelet. Addison disease is a serious life-threatening disorder that affects many organs. If the diagnosis is delayed, it carries very high morbidity and mortality. (Munir & Waseem, 2020)
