What is Addison’s disease?

Addison’s disease, also known as adrenal insufficiency, is an extremely rare disease that occurs when the body cannot produce enough of certain hormones. In Addison’s disease, which is seen in one out of every 100,000 people, glucocorticoid (cortisol) and mineralocorticoid (aldosterone) hormones are reduced in the blood due to the insufficient secretion of the adrenal glands located just above the kidneys.


What causes Addison’s disease?

There are two types of Addison’s disease: primary adrenal insufficiency and secondary adrenal insufficiency. Approximately 70% of primary adrenal insufficiency is due to an autoimmune process. Other causes such as adrenal gland damage, tuberculosis, various bacterial, viral and fungal infections, adrenal gland bleeding, and metastasis of cancer to the adrenal glands can also cause primary adrenal insufficiency. Secondary adrenal insufficiency occurs due to a decrease in the production of the pituitary hormone ACTH (adrenocorticotropic hormone). Cortisol production is not stimulated in ACTH deficiency due to a pituitary tumor or another cause. Aldosterone production is usually not affected in secondary adrenal insufficiency.



What are the symptoms of Addison’s disease?

The symptoms of Addison’s disease vary according to the hormone deficiency. It is necessary to know the functions of these hormones in order to better understand the symptoms of the disease. Cortisol is a hormone that occurs due to stress and is secreted by the adrenal glands. So its most important task is to help the body respond to stress. It also helps the body regulate the use of protein, carbohydrate and fat. It maintains blood pressure and cardiovascular function and controls inflammation. Aldosterone, on the other hand, is a steroid-structured hormone secreted from the outer part of the adrenal glands (cortex), which has an effect on removing potassium from the kidney and reabsorbing sodium, and regulates the electrolyte balance in the body. When aldosterone levels are severely reduced, the kidneys cannot keep salt and water levels in balance. This causes dehydration and low blood pressure.

Addison’s disease symptoms usually develop slowly over a period of several months. Until stress such as illness or injury arises and symptoms become more pronounced and worse, the disease progresses so slowly that some of its symptoms are ignored. The main symptoms of Addison’s disease can be listed as follows;

  • Overstrain
  • Weight loss and severe loss of appetite
  • Fasting hypoglycemia
  • Darkening in the oral mucosa and skin, especially in surgery and scars, nipples and genital areas (pigmentation)
  • Low blood pressure and fainting from it
  • Increased need for salt
  • Low blood sugar (hypoglycemia)
  • Nausea, diarrhea, or vomiting
  • Abdominal pain
  • Pain in the muscles or joints
  • Feeling angry
  • Depression or other behavioral disorders
  • Decreased sweating
  • Decrease in armpit and genital hair growth, especially in women


How is Addison’s disease diagnosed?

For the diagnosis of Addison’s disease, the specialist firstly listens to the patient’s history and examines the clinical findings. In case of doubt, various laboratory tests are performed to determine whether the patient has Addison’s disease and to distinguish between primary and secondary adrenal insufficiency. Tests performed to evaluate the patient’s electrolyte balance, blood sugar level and kidney functions are also necessary to determine the cause of the disease and to direct treatment. In some cases, alternative tests may be ordered, such as the insulin-induced hypoglycemia test, the low-dose ACTH stimulation test, the long-term ACTH stimulation test, or the glucagon stimulation test. Radiological scans such as CT (computed tomography) or MRI (magnetic resonance imaging) may also be used to examine the size and shape of the adrenal glands and pituitary.



How is Addison’s disease treated?

Because adrenal insufficiency causes a lack of functional hormones for the body, doctors often prescribe hormone replacement for the treatment of Addison’s disease. This is done once or twice daily with hydrocortisone tablets, a steroid hormone. If needed, aldosterone can be replaced with fludrocortisone acetate, a synthetic steroid taken orally once a day. These medications should be increased especially at times of stress, infection, surgery or injury. Hormone therapy usually gives successful results. When treatment is successful, people with Addison’s disease can lead a fairly normal life. However, it is recommended that they always carry a doctor alert bracelet and emergency ID card, and keep a small supply of medication at work or school.



What is the Addison’s disease diet like?

Fatigue is one of the most common symptoms of Addison’s disease, but under no circumstances should stimulants, energy drinks, soda, or coffee be used. These beverages extremely stimulate the adrenaline glands due to their high caffeine content. In addition to these, the stimulants and excessive sugar contained in these drinks damage the adrenaline glands. These warnings also apply to cigarettes and tobacco products.
Ready food products containing carbohydrates and refined sugar should be avoided as much as possible. If you also have diabetes along with Addison’s disease, these foods can disrupt the balance of your insulin levels more than normal. These foods increase the symptoms of Addison’s disease, especially in cases where blood sugar is low.
There has been a lot of controversy as to whether salt is beneficial or harmful for Addison’s patients. The truth is that; There is a need for proper nutrition to salt or sodium. Salt and sodium are of particular importance, as low blood sugar is one of the main symptoms of this disease. Getting enough sodium helps keep blood sugar at a certain level. However, you should take care to get this need from high quality sources. Examples of these sources are Himalayan salt and sea salt.
Do not ignore your craving for salt. This situation may be due to a real need. If you sweat a lot, add a little more salt to your food and drink more fluids, especially water.
Excessive stress can cause serious damage to the body by triggering the disease. During stressful times, take care to consume more foods containing vitamin C. Antidepressants also help strengthen your immune system and also help your body adapt better to stress. Thus, adrenaline prevents further damage to your glands. However, the use of antidepressants should be done with the recommendation of a specialist psychiatrist.
Vitamin B intake stimulates the production of certain hormones and neurotransmitters, conductors that transmit impulses from our nervous system. You can increase your consumption of village eggs, shellfish, sardines and salmon to get more B vitamins.
Zinc is important not only for a well-functioning immune system but also for the production of hormones that help fight stress. You can get zinc from seafood, snacks, beans, spinach, and mushrooms. Magnesium calms the nervous system. Avocados, black-eyed peas, bananas, yogurt, cookies and spinach are among the rich sources of magnesium.

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