DEFINITION

Addison's Disease is a life threatening condition caused by partial or complete failure of the adrenal cortex (the outer part of the adrenal gland).

DESCRIPTION

The adrenal glands are a pair of triangular shaped organs that rest on top of the kidneys. They consist of an outer section (the cortex) and a central section (medulla). The main hormones produced by the adrenal cortex are cortisol, aldosterone and dehydroepiandrosterone (DHEA). In Addison's Disease, the secretion of these principle hormones is affected due to destruction of the adrenal cortex. This results in a condition known as adrenal insufficiency.

Cortisol is a steroid hormone and is vital for health. It has many functions which include:
- helping to regulate blood pressure.
- helping to regulate the immune system.
- helping to balance the effect of insulin in regulating the blood sugar level.
- helping the body to respond to stress.
Aldosterone helps to regulate salts in the bloodstream, and helps to control blood pressure.


Due to these disturbances, weakness follows along with lowered resistance to infection, trauma and other stress. Reduced cortisol blood levels also result in an increased production of the hormone ACTH (secreted by the pituitary gland). Blood level of adrenocorticotropic hormone (ACTH) is high and at high concentration this hormone mimics the skin darkening effects of melanocyte stimulating hormone, the result is excessive skin pigmentation, especially in the sun exposed areas and mucous membranes.

CAUSE

Addison's Disease often results from autoimmune processes, infection (especially tubercular or fungal), cancer or haemorrhage in the gland. All three general functions of the adrenal cortex (the outer part of the adrenal gland) may be lost.

SIGNS AND SYMPTOMS

Clinical symptoms include mental lethargy, anorexia, nausea and vomiting, weight loss and hypoglycaemia, which leads to muscular weakness. Loss of aldosterone leads to elevated potassium levels and decreased sodium levels in the blood, low blood pressure, dehydration, decreased cardiac output and arrhythmia. Increased pigmentation is characterised by diffuse tanning of both exposed and non-exposed areas of the body, especially on bony prominences, skin folds and scars.

Symptoms may also include fatigue, loss of appetite, dizziness, moodiness, inability to cope with stress or the person may continually complain of being cold. The person may also suffer from poor healing, recent scars and thinning of the skin.

TREATMENT OPTIONS

Addison's Disease requires treatment under the supervision of a medical practitioner. Patients with Addison's Disease need glucocorticoid treatment replacement therapy and usually mineral corticoid treatment. The underlying cause of the illness needs to be assessed for the appropriate treatment. With continued substitution therapy, the prognosis is excellent and a person with Addison's disease should be able to lead a full life.

PHARMACIST'S ADVICE

Ask your Pharmacist for advice.
1) Check for folic acid, vitamin B12 deficiency. Vitamin B12 is absorbed in the stomach, if there is low stomach acidity absorption of vitamin B12 may be impaired.
2) Liquorice (herb) has anti-inflammatory properties and may be used in some cases of Addison's Disease.
3) Vitamin B complex. All B vitamins are necessary for adrenal function.
4) Vitamin C 4,000 to 8,000 mg daily in divided doses (if diarrhoea present from taking supplement cut down on dose). Vitamin C aids in the proper functioning of the adrenals.
5) Avoid alcohol, caffeine and tobacco. These substances can have detrimental effects adrenal and other glands.
6) Try to avoid stress. Stress management is important for the treatment of this condition. Unresolved stress may lead to adrenal burnout.

DIET HINTS

A person with Addison's Disease is particularly susceptible to the effects of dehydration and salt loss which can result in a mineral imbalance if not managed properly. Addison's Disease causes the body to have difficulty mobilising or burning stored fat which increases the risk of weight gain. These side effects can usually be managed by following a healthy, low sugar, low fat diet which is high in fluids, fresh fruits and vegetables and adequate amounts of protein. Try to drink at least one and a half litres of water per day and more in hot weather or with exercise.

Addison's Disease causes the body to retain potassium so it is advisable to avoid eating large amounts of high potassium fruits such as bananas, apricots (especially dried), dates and raisins. Sports drinks can also contain high levels of potassium.

VITAMINS/MINERALS/HERBS

- Liquorice (herb) may be effectively used in the treatment of Addison's Disease. This herb enhances the activity of mineralocorticoids by inhibiting breakdown of them by the liver. Research has shown that liquorice suppresses the enzyme in humans responsible for inactivating cortisol, aldosterone and progesterone.
- Low stomach acidity has been indicated in people with Addison's Disease. Apple cider vinegar (1 tspn) can be taken 1/2 hour before meals to activate digestive acid. The herb gentian (20 drops) may be taken 1/2 hour before meals. Gentian is a bitter herb and will activate digestive acids. Other digestive supplements that may be taken are:
- Slippery Elm promotes growth of the beneficial bacteria in the bowel. If upper digestion is sluggish this may lead to fermentation of undigested food and therefore toxic byproducts plus overgrowth of unwanted bowel bacteria such as candida.
- Ginger may be taken as it aids in stimulating digestion and has an anti nausea effect. The herb also increases circulation to the gut.
- Multivitamins and minerals can help to provide the body with additional nutrients, however Addison's Disease causes the body to retain potassium and lose sodium, so it is advisable to avoid nutritional supplements that are high in potassium.

NOTES

A person with Addison's Disease MUST be under the supervision of a medical practitioner and take the recommended medication. The supplements indicated are for support only.

ORGANISATIONS and SUPPORT GROUPS

See the Australian Addison's Disease Association topic on the Healthpoint.

Provided by