Addison’s Disease

Overview:    

• Adrenal insufficiency results from inadequate secretion of cortisol and/or aldosterone.
• It is potentially fatal and notoriously variable in its presentation. A high index of suspicion is therefore required in patients with unexplained fatigue, hyponatraemia or hypotension.
• Congenital adrenal hyperplasias and Addison’s disease (primary adrenocortical failure) are rare causes. [2]

Indian epidemiology then other

Causes of Addison’s Disease:

• Autoimmune adrenalitis
• Infections – Tuberculosis. Cytomegalovirus also fungal infections associated with AIDS.
• Tumours – Metastatic disease (notably from breast)
• Inherited disorders – e.g. adreno leukodystrophies and familial isolated glucocorticoid deficiency.
• Secondary deposits,
• Granulomatous disease, amyloidosis
• Haemochromatosis, fungal disease (e.g. histoplasmosis)
• Congenital adrenal hyperplasia,
• Meningococcal septicaemia, haemorrhage into adrenals, e.g. in new born or as complication of anticoagulant therapy, adrenal vein thrombosis after trauma or adrenal venography.
• Drugs, e.g. rifampicin, ethionamide, ketoconazole.[1]

Primary Adrenal Insufficiency

Secondary Adrenal Insufficiency

Tertiary Adrenal Insufficiency

You may be at a higher risk for Addison’s disease if you I.E.:

• have cancer
• take anticoagulants (blood thinners)
• have chronic infections like tuberculosis
• had surgery to remove any part of your adrenal gland
• have an autoimmune disease, like type 1 diabetes or Graves’ disease[6]

Tab Content

Tab Content

Sign & Symptoms of Addison’s Disease

• Weight loss also anorexia
• Malaise, weakness
• Nausea, vomiting
• Diarrhoea
• Constipation
• Postural hypotension
• Shock
• Hypoglycaemia
• Hyponatraemia
• Hypercalcaemia

Onset – usually insidious, Rarely first manifestation may be acute crisis.

1. Pigmentation of skin and mucous membranes – Varieties –

• Bluish black discoloration, or brownish patches or streaks on lips, gums, inside of cheeks.
• Hyper pigmentation of extensor surfaces such as face, neck, dorsum of hands also of forearms.
• Multiple black freckles especially on the forehead, face, neck, shoulders also arms.

2. Gastrointestinal symptoms –  for example, Anorexia, often with nausea and vomiting, Constipation with intermittent diarrhoea, Salt craving, Abdominal pain, Irritation of the diaphragm.
3. Cardio-vascular system – such as Postural hypotension, Faintness ,Dyspnoea, Heart sounds feeble.
4. Muscular system – Muscular weakness, and wasting with Creatinuria, Muscle cramps.
5. Mental and nervous – Lassitude and muscle weakness are invariable and the first symptom to appear in majority of cases, additionally, Loss of memory, drowsiness.
6. Genital system – Impotence and amenorrhoea, Symptoms may be aggravated at the time of menstruation or menopause.
7. Kidneys –Kidney function is severely impaired, the excretion of urine is diminished and it contains granular casts and albumin, also the blood urea and creatinine rise above normal.
8. Miscellaneous – Subnormal temperature, anemia,Loss of body hair in females.
9. Other autoimmune disease – Such as vitiligo, thyroiditis, hypothyroidism, pernicious anaemia, hyperparathyroidism, insulin-dependent diabetes mellitus, mucocutaneous candidiasis.
10. Increased secretion of ACTH- Pigmentation of skin in areas exposed to light, in oral mucosa, gums.
11. Deficiency of adrenal cortisol secretion,Cortisol,Aldosterone, Androgens- Asthenia Pigmentation of points of pressure (e.g. elbows and mucus membrane, e.g. genital regions, mouth) Anorexia, nausea Weight loss Decreased tolerance to stressful situation Hypotension, postural syncope, Diminished axillary and pubic hair growth in females.

Appearance i.e.

The patient may be dehydrated and lethargic.

Vitals i.e.

• Low blood pressure
• Orthostatic hypotension
• Fever

Skin i.e.

• Pigmented skin and mucous membranes – darkening (hyperpigmentation) of the skin, including areas not exposed to the sun; characteristic sites are skin creases (e.g. of the hands), nipples, and the inside of the cheek (buccal mucosa), also old scars may darken.
• Vitiligo may be present.
• Absence of axillary and pubic hair in females as a result of loss of adrenal androgens.
• Pallor may be present.

Neck i.e.

• Goiter may be present.

Extremities i.e.

• Weakness

Neurologic i.e.

• Confusion may be present
• Seizures may be present.[8]

Diagnosis of Addison’s Disease

First about to take medical history an signs and symptoms. You may undergo some of the following tests:

• Blood test
• ACTH stimulation test
• Insulin-induced hypoglycemia test
• Imaging tests [1]

Differential Diagnosis

Secondary adrenal insufficiency (pituitary failure) i.e.:

• Long-term steroid use
• Pituitary apoplexy
• Pituitary infiltrative disorders

Tertiary adrenal insufficiency (hypothalamic failure) i.e.:

• Pituitary stalk transection
• Hypothalamic stroke
• Central nervous system radiation

Diseases that manifest with hyperpigmentation must be differentiated from Addison disease i.e.

• Scleroderma
• Hemochromatosis
• POEMS syndrome
• Primary biliary cirrhosis
• Drug-induced pigmentation
• Erythema dyschromicum perstans
• Metastatic melanoma [11]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

If Addison’s disease is suspected, blood tests will be carried out to measure the levels of sodium, potassium and cortisol in your body. A low sodium, high potassium or low cortisol level may indicate Addison’s disease.

You may need to see a hospital hormone specialist (endocrinologist) for your blood to be tested for the following:

• a low level of the hormone aldosterone
• a high level of adrenocorticotrophic hormone (in other words, ACTH)
• a low level of glucose (sugar used for energy)
• positive adrenal antibodies (antibodies designed to attack the adrenal gland)

Any of the above could be a sign of Addison’s disease.[9]

Treatment

All treatment for Addison’s disease involves medication. You will be given hormone replacement therapy to correct the levels of steroid hormones your body isn’t producing.

Some options for treatment include oral corticosteroids such as i.e.:

• Hydrocortisone, prednisone or methylprednisolone to replace cortisol.
• Fludrocortisone acetate to replace aldosterone.

Treatment for an Addisonian crisis, which is a medical emergency, typically includes intravenous injections of i.e.:

• Corticosteroids
• Saline solution
• Sugar (dextrose)[1]

1. Do not stop taking steroids suddenly.

2. Do not miss daily steroid doses for more than 24 hours (accidentally missing a dose, vomiting more than 24 hours, hospitalization without continuation of medication, etc.).

3. Know when stress doses should be given (severe illness, surgery, or trauma).[12]

Homeopathic Treatment of Addison’s Disease

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic medicines for Addison’s Disease:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Alumina:

• Dryness of mucous membranes.
• Eructation in spare, dry, but thin.
• Old people or prematurely aged. No desire to eat. Can swallow but small morsels at a time.
• Especially, indicated when confused as to personal identity. Low-spirited. Constipation. Menses scanty, pale.
• Worse – cold air, after eating, standing. On the other hand, Better – warmth, fasting, resting in bed.

Arsenic album:

• Gradual loss of weight from impaired nutrition.
• Great anguish also restlessness.
• General sensibility increased.
• Cannot bear either the sight or smell of food.
• Nausea, retching, vomiting after eating or drinking. Particularly, in anxiety in pit of stomach.

Cocculus:

• For travel nausea and sickness.
• Fever is gone but the patient does not rally, there is much nervous trembling, numbness, twitching of muscles and great weakness.
• Violent attacks of gastralgia, due to violent cramp of the stomach. Griping, pinching, constrictive pain.
• From grief ,anxiety, and from prolonged loss of sleep. Also in Headache, vertigo, nausea.
• The woman is emaciated, and grows more and more sickly and chlorotic. [5]

Natrum Muriaticum:

• Great weakness and weariness.
• Especially indicated when oversensitive to all sorts of influences.
• Depressed particularly in chronic diseases. Hungry, yet loose flesh.
• Unquenchable thirst.
• Sweats while eating. Wants to be alone to cry.
• Tears with laughter.
• Menses either irregular or suppressed. Additionally, heart fluttering or palpitation

Opium:

• With either coma or complete inactivity.
• Extremities and face are either bluish or a livid colour.
• Loud breathing, convulsions also trembling.

Phosphorus:

• Firstly, A picture of phosphorus for Addison’s Disease is, destructive metabolism.
• Secondly, thin, transparent skin weakened by loss of animal-fluids, with great nervous debility and emaciation.
• Then, Great lowness of spirits. Easily vexed. Fearful.
• Throws up ingest by mouthfuls.
• The food scarcely swallowed, comes up again. Additionally, pain in stomach relieved by cold food.
• Long, narrow, hard stools difficult to expel. Also, Amenorrhoea.
• At last, heart violent palpitations with anxiety.[4]

Veratrum album:

• Cold sweat on forehead also body.
• Marked by violence and destructiveness; wants to destroy, to tear something; tears the clothes from the body. In Addition, always wants to be busy, to carry on his daily work.
• Vomiting forcible and excessive.
• After that, nausea with weakness; is obliged to lie down
• intense cramps in the stomach; similarly, cramps in the muscles of the abdomen like colic. [5]

Diet & Regimen of Addison’s Disease

People with Addison’s disease should also eat a well-balanced, nutritious diet rich in fruits, vegetables, whole grains, and proteins. For instance:

• Milk
• Cheese
• Yogurt
• Ricotta cheese
• Soy milk
• Turnip greens
• Kale
• Broccoli[3]

Tab Content

Tab Content

References use for Article Addison’s disease

[1]Davidson’s principles and practice of medicine-Churchill Livingstone Elsevier (2014)

[2] Medicine Golwala

[3] The Bhanja Homoeopathic Prescriber By K. C.

[3]https://www.mayoclinic.org/diseasesconditions/addisons-disease/diagnosis-treatment/drc-20350296

[4] Australian Homoeopathic Home Prescriber Part 1

[5] Kent’s_Homeopathy_Materia_Medica

[6]https://www.healthline.com/health/addisons-disease#risk-factors

[7]https://www.ncbi.nlm.nih.gov/books/NBK279083/

[8]https://www.wikidoc.org/index.php/Addison%27s_disease_physical_examination

[10]https://www.nhs.uk/conditions/addisons-disease/diagnosis/#:~:text=If%20Addison’s%20disease%20is%20suspected,level%20may%20indicate%20Addison’s%20disease.

[11]https://www.visualdx.com/visualdx/diagnosis/addison+disease?diagnosisId=51066&moduleId=101

[12]https://www.parentprojectmd.org/care/care-guidelines/by-area/steroids/risk-for-adrenal-crisis/