Primary and secondary forms
In the primary form, called Addison's disease, the adrenal glands themselves are affected. The pituitary gland in response intensively produces ACTH, and its excess stimulates the pigment cells of the skin - hence the characteristic darkening. Usually aldosterone also decreases, so sodium is lost, blood pressure drops and a craving for salty foods appears. In the secondary form, the pituitary gland suffers: ACTH is low, cortisol is low, but aldosterone production is maintained, and the skin does not darken. The most common cause of the secondary form is abrupt withdrawal of long-term glucocorticoids.
- Primary form: damage to the adrenal glands, darkening of the skin
- Secondary form: lack of ACTH, normal skin color
- Autoimmune damage is a common cause of the primary form
- Adrenal tuberculosis
- Abrupt withdrawal of glucocorticoids is a common cause of the secondary form
- Hemorrhage into the adrenal glands during severe infections
Symptoms that take months to develop
The disease begins unnoticed. The person notes increasing fatigue that does not go away after rest, loss of appetite and weight, nausea, episodes of abdominal pain, dizziness when standing up. An unusual craving for salty foods appears. In the primary form, the skin acquires a bronze tint, the folds of the palms, elbows, postoperative scars, gums and cheek mucosa darken. Women report hair loss in the armpits and pubic area. Children may experience growth retardation and vomiting. All these signs can easily be attributed to overwork, so it is important to bring them to the attention of a doctor.
- Constant weakness and fatigue
- Loss of weight and appetite
- Nausea, vomiting, abdominal pain
- Dizziness and low blood pressure
- Salty cravings
- Darkening of the skin and mucous membranes in the primary form
- Decreased mood and irritability
Adrenal crisis: an emergency
A crisis develops when the need for cortisol increases sharply, and the body cannot meet it: during an infection with a high fever, an intestinal infection with vomiting, injury, surgery, or when a drug is missed. The condition worsens quickly: weakness, vomiting and diarrhea increase, blood pressure drops sharply, severe abdominal pain, confusion, and possible loss of consciousness appear. This is a threat to life, help is needed immediately. People diagnosed with the disease should carry a card with information about the disease and a previously trained loved one.
- Provocateurs: infection, vomiting, trauma, surgery, missed medication
- Sudden weakness and drop in blood pressure
- Vomiting, diarrhea, dehydration
- Abdominal and back pain
- Confusion and loss of consciousness
- Immediate call for ambulance 103
Diagnostics
The basis is the determination of cortisol in the morning along with ACTH: low cortisol with high ACTH indicates the primary form, with low ACTH - the secondary form. In doubtful cases, a stimulation test is performed, which shows the adrenal reserve. Additionally, sodium, potassium, glucose, and renal function are assessed. To determine the cause of the primary form, antibodies are examined and imaging of the adrenal glands is performed, and in the secondary form, MRI of the pituitary gland is performed. Before the tests, the doctor clarifies all medications taken, because they affect the result.
- Morning cortisol and ACTH
- Stimulation test
- Sodium, potassium, glucose, creatinine
- Antibodies for suspected autoimmune lesions
- Ultrasound or tomography of the adrenal glands
- MRI of the pituitary gland in the secondary form
Treatment and rules of life with a diagnosis
The treatment is replacement and lifelong: the drug replaces the missing cortisol, the dose is distributed throughout the day, imitating the natural rhythm. In the primary form, a mineralocorticoid is additionally prescribed, and there is no need to limit salt. The most important rule is the sick day rule: in case of fever, infection, injury or preparation for surgery, the dose is temporarily increased according to a scheme previously agreed upon with the doctor. If vomiting occurs, the tablets are not absorbed and an injection form or urgent hospitalization is required. You cannot stop taking the drug yourself under any circumstances.
- Lifelong replacement therapy according to a doctor’s regimen
- Mineralocorticoid in the primary form
- Increasing the dose for illness, fever, surgery
- Injectable form of the drug at home in case of vomiting
- Card or bracelet with information about the diagnosis
- Teaching loved ones what to do in a crisis
- Regular examinations by an endocrinologist