Addison's disease

Addison's disease (also known as chronic adrenal insufficiency, or hypocortisolism) is a rare endocrine disorder, first described by British physician Thomas Addison. It is estimated that it affects about 1 to 2 in 100,000 people. It occurs when the adrenal glands, seated above the kidneys, fail to produce enough of the hormone cortisol and, sometimes, the hormone aldosterone. Addison's disease refers specifically to primary adrenal insufficiency, in which the adrenal glands themselves malfunction; secondary adrenal insufficiency occurs when the pituitary gland does not produce enough adrenocorticotropic hormone (ACTH) to adequately stimulate the adrenal glands. A famous sufferer of Addison's Disease was President John F. Kennedy. Jane Austen is thought to have been another.

Signs and symptoms

Early signs

Addison's disease progresses slowly, and symptoms may not present or be noticed until some stressful illness or situation occurs. Common symptoms are:

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• chronic fatigue that gradually worsens
• muscle weakness
• loss of appetite
• weight loss
• nausea/vomiting
• diarrhea
• low blood pressure that falls further when standing (orthostatic hypotension)
• areas of hyperpigmentation (darkened skin), known as melasma suprarenale.
• irritability
• depression
• craving for salt and salty foods
• hypoglycaemia (worse in children)
• for women, menstrual periods that become irregular or cease
• tetany (particularly after drinking milk) due to phosphate excess
• numbness of the extremities, sometimes with paralysis, due to potassium excess

Addisonian crisis

An illness or accident can aggravate the adrenal problems and cause an Addisonian crisis in which the symptoms include:

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• brown coating on tongue and teeth due to iron loss hemolysis
• sudden penetrating pain in the legs, lower back or abdomen
• severe vomiting and diarrhea, resulting in dehydration
• low blood pressure
• loss of consciousness
• hypoglycemia

Untreated, an Addisonian crisis can be fatal. It is a medical emergency.

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