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 5 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. The endocrine system is a control system of ductless endocrine glands that secrete chemical messengers called hormones that circulate within the body via the bloodstream to affect distant organs. ... A physician is a person who practices medicine. ... Thomas Addison (1793 - June 29, 1860) was a physician at Guys Hospital who worked in the team of doctors led by Sir Astley Paston Cooper. ... In mammals, the adrenal glands (also known as suprarenal glands) are the triangle-shaped endocrine glands that sit atop the kidneys. ... Kidneys viewed from behind with spine removed The kidneys are bean-shaped excretory organs in vertebrates. ... A hormone (from Greek horman - to set in motion) is a chemical messenger from one cell (or group of cells) to another. ... Cortisol (hydrocortisone, C21H30O5 ), is a corticosteroid hormone synthesized in the zona fasciculata of the cortex of the adrenal glands. ... Aldosterone is a steroid synthesized in the mid-section of the adrenal cortex of the adrenal gland. ... Located at the base of the skull, the pituitary gland is protected by a bony structure called the sella turcica. ... Adrenocorticotropic hormone (ACTH or corticotropin) is a polypeptide hormone secreted from corticotropes in the anterior lobe of the pituitary gland in response to corticotropin-releasing hormone (CRH) released by the hypothalamus. ... Order: 35th President Vice President: Lyndon B. Johnson Term of office: January 20, 1961 – November 22, 1963 Preceded by: Dwight D. Eisenhower Succeeded by: Lyndon B. Johnson Date of birth: May 29, 1917 Place of birth: Brookline, Massachusetts Date of death: November 22, 1963 Place of death: Dallas, Texas First... Jane Austen, in a portrait based on one drawn by her sister Cassandra House of Jane Austen (today it is a museum) Jane Austen (December 16, 1775–July 18, 1817) was a prominent English novelist whose work is considered part of the Western canon. ...

The condition is very common in dogs, particularly the Bearded Collie. In dogs it is inherited via the female line - possibly due to autoimmune antibodies in the milk. In humans it is never hereditary. Common nicknames Beardie Country of origin United Kingdom Classification Breed standards (external links) FCI, AKC, ANKC, CKC KC(UK), NZKC, UKC The Bearded Collie or beardie is the traditional dog of the Scottish shepherd. ...

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:

• 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) particularly at sites of injury or pressure.
• irritability
• depression
• craving for salt and salty foods has been reported, but not in the last century.
• 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

Fatigue is a feeling of excessive tiredness or lethargy, with a desire to rest, perhaps to sleep. ... A top-down view of skeletal muscle Muscle is a contractile form of tissue. ... Nausea (Greek Ναυτεία) is the sensation of unease and discomfort in the stomach with an urge to vomit. ... Diarrhea in American English, (spelled diarrhoea in other anglophone countries) is a condition in which the sufferer has frequent and watery or loose bowel movements (from the ancient Greek word διαρροή = leakage; lit. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... Orthostatic hypotension (also known as postural hypotension) is a sudden fall in blood pressure that occurs when a person assumes a standing position. ... In everyday language depression refers to any downturn in mood, which may be relatively transitory and perhaps due to something as trivial as your team losing. ... In chemistry, salt is a general term used for ionic compounds composed of positively charged cations and negatively charged anions, so that the product is neutral and without a net charge. ... Hypoglycemia is a medical term referring to a pathologic state produced and usually defined by a lower than normal amount of sugar (glucose) in the blood. ... The menstrual cycle is the periodic change in a womans body that occurs every month between puberty and menopause and that relates to reproduction. ... Tetany is the point at which signals from nerves (action potentials) are arriving to skeletal muscle rapidly enough in succession to cause a steady contraction, and not just a series of individual twitches. ... In chemistry, a phosphate is a polyatomic ion or radical consisting of one phosphorus atom and four oxygen. ... General Name, Symbol, Number potassium, K, 19 Series alkali metals Group, Period, Block 1(IA), 4, s Density, Hardness 856 kg/m3, 0. ...

Addisonian crisis

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

• 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. Hemolysis (alternative spelling haemolysis) is the excessive breakdown of red blood cells. ... Dehydration is the removal of water (hydor in ancient Greek) from an object. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... In medicine, a coma (from the Greek koma, meaning deep sleep) is a profound state of unconsciousness, which may result from a variety of conditions including intoxication (drug, alcohol or toxins), metabolic abnormalities (hypoglycemia, hyperglycemia, ketoacidosis, etc. ... Hypoglycemia is a medical term referring to a pathologic state produced by a lower than normal amount of sugar (glucose) in the blood. ... A medical emergency is an injury or illness that poses an immediate threat to a persons health or life which requires help from a doctor or hospital. ...

Diagnosis

In suspected cases of Addison's disease, one needs to demonstrate that adrenal hormone levels are low after appropriate stimulation with synthetic pituitary hormone. Once demonstrated, the cause of adrenal failure needs to be elucidated. The most common cause is autoimmune, and can be tested for with an assay for 21-hydroxylase antibodies. If there are no antibodies present, infectious or genetic causes should be sought. This may include imaging of the adrenal glands, tests for tuberculosis or HIV infection, and searching for metastatic cancer. Medical imaging is the process by which physicians evaluate an area of the subjects body that is not normally visible. ...

Pathophysiology

Eighty to ninety percent of cases of Addison's disease are said to be due to autoantibodies directed against adrenal cells containing 21-hydroxylase, an enzyme involved in the production of cortisol and aldosterone. The remainder of cases are due to tuberculosis, HIV, sarcoidosis, amyloidosis, hemochromatosis, metastatic cancer to the adrenal glands, adrenal haemorrhage and congenital adrenal hyperplasia. Addison's disease can be an expression of an autoimmune polyendocrine syndrome when autoimmune reactions against other organs are also present. In APS type 1, 70% suffer from Addison's disease, while in type 2, 100% do. Through these syndromes, Addison's is associated with hypothyroidism, diabetes mellitus (type 1),vitiligo, alopecia and celiac disease. Tuberculous lungs show up on an X-ray image Tuberculosis is an infection with the bacterium Mycobacterium tuberculosis, which most commonly affects the lungs (pulmonary TB) but can also affect the central nervous system (meningitis), lymphatic system, circulatory system (miliary TB), genitourinary system, bones and joints. ... HIV (Human Immunodeficiency Virus) is a retrovirus that infects cells of the human immune system. ... Haemochromatosis, also spelled hemochromatosis, is a hereditary disease characterized by improper processing by the body of dietary iron which causes iron to accumulate in a number of body tissues, eventually causing organ dysfunction. ... When normal cells are damaged or old they undergo apoptosis; cancer cells, however, avoid apoptosis. ... Congenital adrenal hyperplasia (CAH) refers to any of several autosomal recessive diseases resulting from defects in steps of the synthesis of cortisol from cholesterol by the adrenal glands. ... In medicine, autoimmune polyendocrine syndromes are a heterogenous group of rare diseases characterised by autoimmune activity against more than one endocrine organs, although non-endocrine organs can be affected. ... Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ... Hypothyroidism is the disease state caused by insufficient thyroid hormone by the thyroid gland. ... Diabetes mellitus is a medical disorder characterized by varying or persistent hyperglycemia (elevated blood sugar levels), especially after eating. ... Vitiligo (or leukoderma) is the patchy loss of skin pigmentation due to an auto-immune attack by the bodys own immune system on skin melanocytes. ... Alopecia is a set of disorders ranging from male and female pattern alopecia (alopecia androgenetica), to alopecia areata, which involves the loss of some of the hair from the head, alopecia totalis, which involves the loss of all head hair, to the most extreme form, alopecia universalis, which involves the... Coeliac disease (also termed non-tropical sprue, celiac disease and gluten intolerance) is an autoimmune disease characterised by chronic inflammation of the proximal portion of the small intestine caused by exposure to certain dietary gluten proteins. ...

Treatment

Treatment for Addison's disease involves replacing the missing cortisol and, if necessary, providing replacement therapy for the missing aldosterone. Caution must be exercised when the person with Addison's disease has surgery or becomes pregnant. A typical modern surgery operation For other meanings of the word, see Surgery (disambiguation) Surgery (from the Greek cheirourgia - lit. ... A pregnant woman Pregnancy is the process by which a mammalian female carries a live offspring from conception until it develops to the point where the offspring is capable of living outside the womb. ...

Reference

• Addison T. On the constitutional and local effects of disease of the suprarenal capsules. London: P. Highley, 1855. An exact reprint with colour images is available via the external link below.

External links

• Addison's disease: adrenal insufficiency
• Addison's disease self help group
• Addison's own book
• Greenhow's pan-European survey