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Addison's Disease === Not enough hormone needs to be added!

ADDISONS DISEASE = ADRENAL INSUFFICIENCY :== Acute adrenal


crisis
is a life-threatening condition that occurs when there is not enough cortisol,
Adrenal insufficiency is an endocrine-or hormonal-disorder that occurs when the adrenal glands do
not produce enough of certain hormones. The gradual destruction of the adrenal cortex, the outer
layer of the adrenal glands, by the body's immune system causes up to 80 percent of Addison's
disease cases.
2
n autoimmune disorders, the immune system ma!es antibodies that attac! the
body"s own tissues or organs and slowly destroy them.
Adrenal insufficiency occurs when at least #0 percent of the adrenal cortex has been destroyed. As a
result, often both cortisol and aldosterone are lac!ing.
$rimary adrenal insufficiency, also called Addison's disease, occurs when the adrenal glands are
damaged and cannot produce enough of the hormone cortisol and often the hormone aldosterone.
%econdary adrenal insufficiency occurs when the pituitary gland-a bean-si&ed organ in the brain-fails
to produce enough adrenocorticotropin 'A(T)*, a hormone that stimulates the adrenal glands to
produce cortisol. f A(T) output is too low, cortisol production drops. +,entually, the adrenal glands
can shrin! due to lac! of A(T) stimulation. %econdary adrenal insufficiency is much more common
than Addison's disease.
Cortisol
(ortisol belongs to a class of hormones called glucocorticoids, which affect almost e,ery organ and
tissue in the body. (ortisol's most important -ob is to help the body respond to stress. Among its
many ,ital tas!s, cortisol helps
maintain blood pressure and cardio,ascular function
slow the immune system's inflammatory response
maintain le,els of glucose-a form of sugar used for energy-in the blood
regulate the metabolism of proteins, carbohydrates, and fats
The amount of cortisol produced by the adrenals is
precisely balanced. (ortisol is regulated by the brain's
hypothalamus and the pituitary gland. .irst, the
hypothalamus releases a /trigger/ hormone called
corticotropin-releasing hormone '(0)* that signals the
pituitary gland. The pituitary responds by sending out
A(T), which in turn stimulates the adrenal glands. The
adrenal glands respond by producing cortisol. (ompleting
the cycle, cortisol then signals bac! to both the pituitary
and hypothalamus to decrease these trigger hormones.
Aldosterone
Aldosterone belongs to a class of hormones called mineralocorticoids, also produced by the adrenal
glands. Aldosterone helps maintain blood pressure and water and salt balance in the body by
helping the !idneys retain sodium and excrete potassium. 1hen aldosterone production falls too low,
the !idneys are not able to regulate water and salt balance, leading to a drop in both blood ,olume
and blood pressure.
Symptoms of Addison's Disease or adrenal insufficiency
The symptoms of adrenal insufficiency usually begin gradually. The most common symptoms are
chronic, worsening fatigue
muscle wea!ness
loss of appetite
weight loss
Other symptoms
nausea
,omiting
diarrhea
low blood pressure that falls further when standing, causing di&&iness or fainting
irritability and depression
a cra,ing for salty foods due to salt loss
hypoglycemia, or low blood glucose
headache
sweating
in women, irregular or absent menstrual periods
Treatment of adrenal insufficiency in,ol,es replacing, or substituting, the hormones that the adrenal
glands are not ma!ing. (ortisol is replaced with a synthetic glucocorticoid such as hydrocortisone,
prednisone, or dexamethasone, ta!en orally once to three times each day, depending on which
medication is chosen. f aldosterone is also deficient, it is replaced with oral doses of a
mineralocorticoid, called fludrocortisone acetate '.lorinef*, ta!en once or twice a day. 2octors
usually ad,ise patients recei,ing aldosterone replacement therapy to increase their salt inta!e.
2uring an Addisonian crisis, low blood pressure, low blood glucose, and high le,els of potassium
can be life threatening. %tandard therapy in,ol,es intra,enous in-ections of glucocorticoids and large
,olumes of intra,enous saline solution with dextrose, a type of sugar. This treatment usually brings
rapid impro,ement. 1hen the patient can ta!e fluids and medications by mouth, the amount of
glucocorticoids is decreased until a maintenance dose is reached. f aldosterone is deficient,
maintenance therapy also includes oral doses of fludrocortisone acetate.
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