Addison’s disease results when your adrenal glands are damaged, producing insufficient amounts of the hormone cortisol and often aldosterone as well. These glands are located just above your kidneys. As part of your endocrine system, they produce hormones that give instructions to virtually every organ and tissue in your body.
Approximately 140 people out of every million are affected by Addison’s disease. President John F. Kennedy had Addison’s disease as did his sister Eunice Kennedy Shriver. Other well-known people who had this rather rare disease include Dr. Thomas Addison (for whom the disease was named), singer Helen Reddy and artist Ferdinand Louis Schlemmer. Even writers Jane Austen and Charles Dickens were suspected of having the disease.
Primary adrenal insufficiency
Addison’s disease occurs when the cortex is damaged and doesn’t produce its hormones in adequate quantities. Doctors refer to the condition involving damage to the adrenal glands as primary adrenal insufficiency.
The failure of your adrenal glands to produce adrenocortical hormones is most commonly the result of the body attacking itself (autoimmune disease). For unknown reasons, your immune system views the adrenal cortex as foreign, something to attack and destroy.
Secondary adrenal insufficiency
Adrenal insufficiency can also occur if your pituitary gland is diseased. The pituitary gland makes a hormone called adrenocorticotropic hormone (ACTH), which stimulates the adrenal cortex to produce its hormones. Inadequate production of ACTH can lead to insufficient production of hormones normally produced by your adrenal glands, even though your adrenal glands aren’t damaged. Doctors call this condition secondary adrenal insufficiency.
Another more common cause of secondary adrenal insufficiency occurs when people who take corticosteroids for treatment of chronic conditions, such as asthma or arthritis, abruptly stop taking the corticosteroids.
What are the main adrenal hormones and why are they important?
Cortisol is one of the glucocorticoid hormones produced by the adrenal glands. Cortisol is used by almost every single organ and tissue in the body. It helps the body respond to stress. It also takes care of and maintains heart and blood vessel function and keeps blood pressure controlled. It helps to regulate metabolism and use food efficiently in the body. Cortisol slows the immune system’s inflammatory response to help protect against bacteria, viruses, and harmful substances in the body.
Cortisol is ultimately controlled by the hypothalamus and the pituitary glands. The hypothalamus sends out CRH to the pituitary gland, which sends ACTH to the adrenal glands and stimulates cortisol production. Once cortisol levels have reached the required level, a message is then sent back to both the hypothalamus and the pituitary to decrease their hormones.
Aldosterone is a hormone belonging to the mineralocorticoid family that is also produced by the adrenal glands. This hormone helps with blood pressure control and at the same time helps to balance our sodium and potassium levels. When aldosterone is not secreted in the correct amounts, the body can lose too much sodium and retain too much potassium.
Sodium in the blood affects both blood volume and blood pressure. Having too little sodium in the body causes the condition hyponatremia, which usually leads to symptoms of feeling fatigued and confused with muscle twitches. Too much potassium can lead to hyperkalemia which has no symptoms but may sometimes produce irregular heartbeats, nausea, and a weak pulse.
Dehydroepiandrosterone (DHEA) is also produced by the adrenals and is used to make androgen and estrogen (male and female sex hormones). Men get most androgens from the testes and women get most of their estrogen from the ovaries. When adrenal insufficiency exists, the glands may not make enough DHEA.
The most common symptoms of adrenal insufficiency include:
- Chronic fatigue
- Muscle weakness
- Abdominal pain
- Loss of appetite
- Weight loss
Other symptoms of the disease may include:
- Nausea, vomiting
- Low blood pressure that may cause dizziness or fainting with standing
- Irritability and depression
- Skin darkening on scars, skin folds, lips, elbows, knees, knuckles, toes, and mucous membranes of the cheek. This hyperpigmentation occurs only in Addison’s and not in secondary adrenal insufficiency.
- Hypoglycemia (low blood sugar)
- Craving salty foods
- Irregular or nonexistent menstrual periods
- Loss of interest in sex in women