Understanding Addison's Disease: Symptoms, Diagnosis, and Lifelong Management

Addison's disease, also known as primary adrenal insufficiency or hypoadrenalism, is a rare but serious disorder that affects the adrenal glands. These small glands sit atop your kidneys and are responsible for producing two essential hormones: cortisol and aldosterone. In Addison's disease, the adrenal glands are damaged and fail to produce adequate amounts of these hormones, leading to a variety of health issues.

The condition is relatively rare, with around 9,000 diagnosed cases in the United Kingdom and approximately 300 new cases each year. In Western countries, the most common cause of Addison's disease is autoimmunity, which accounts for about 90% of the cases. Given its rarity and the non-specific nature of its symptoms, diagnosing Addison's disease can often be delayed.

Early-stage symptoms of Addison's disease are easily mistaken for more common health conditions such as depression or the flu. Patients may report a lack of energy or motivation, describing constant fatigue. Other symptoms include muscle weakness, low mood, loss of appetite, unintentional weight loss, and increased thirst. Over time, these issues can become more severe, leading to symptoms like dizziness, fainting, cramps, and exhaustion. Additionally, patients may develop small areas of darkened skin, lips, or gums.

If you suspect someone has Addison's disease, certain investigations can help confirm the diagnosis. In a primary care setting, a simple urea and electrolyte blood test might reveal low sodium and high potassium levels. A 9 am serum cortisol test can also be informative. If the serum cortisol level is less than 100 nanomoles per liter, the person should be admitted to the hospital as adrenal insufficiency is highly likely. If the serum cortisol level is between 100 and 500 nanomoles per liter, the person should be referred to an endocrinologist for further investigations. The gold standard for diagnosing Addison's disease is the adrenocorticotrophic hormone (ACTH) stimulation test, commonly known as the Synacthen test, conducted in a secondary care setting.

Management of Addison's disease involves both emergency and long-term strategies. If an adrenal crisis is suspected—where the person is acutely unwell or has low blood pressure—emergency admission should be arranged immediately. Untreated adrenal crises can be rapidly fatal. In such cases, hydrocortisone should be administered intramuscularly or intravenously before transferring the patient to the hospital.

For more stable or non-emergency situations, treatment is usually initiated and adjusted by a specialist endocrinologist. Hydrocortisone is typically used for glucocorticoid replacement, while fludrocortisone is used for mineralocorticoid replacement. It is crucial for patients to increase their corticosteroid cover during physical stress, such as illness, injury, or surgery, to prevent an adrenal crisis. Patients should also be educated on recognizing the symptoms of an adrenal crisis and have intramuscular hydrocortisone available for emergencies. Additionally, carrying identification like a MedicAlert bracelet or card indicating they have Addison's disease is vital for first responders in case of an emergency.

Understanding and managing Addison's disease is a lifelong commitment, but with proper treatment and vigilance, patients can lead relatively normal lives. If you found this information helpful, consider exploring additional resources linked in the description box of my video. These resources offer further reading and information that can deepen your understanding of this condition.

If you enjoyed the video, please give it a thumbs up and subscribe to the channel for new content every Wednesday and Sunday. Your support helps us continue to provide valuable information. If you have any questions, comments, or queries, feel free to leave them in the comments section below, and I'll be sure to respond.

For those in the medical field looking to scale their brand on YouTube or interested in sponsoring our videos with their products, please reach out to book a consultation. Your support not only helps us grow but also enables us to continue providing high-quality, informative content.

Thank you for reading, and until next time, stay informed and take care.