the ideal opportunity to remove or suppress the
responsible tumor.
See also ADENOMA-TO-CARCINOMA TRANSITION;
HORMONE; HYPERHIDROSIS; INTESTINAL POLYP.
Addison’s disease Damage to or progressive fail-
ure of the adrenal cortex of the ADRENAL GLANDS,
resulting in insufficient production of the hor-
mones CORTISOLand ALDOSTERONE. The most com-
mon cause of Addison’s disease, also called primary
ADRENAL INSUFFICIENCY, is autoimmune, in which the
IMMUNE SYSTEMattacks the cells of the adrenal cor-
tex. Doctors do not know what precipitates such an
attack. Other causes include events that can dam-
age or destroy adrenal tissue such as INFECTIONthat
infiltrates the adrenal gland tissue (notably TUBER-
CULOSIS), blunt trauma or other injury to the
abdomen, and tumors. Because the body cannot
make up for the lost function of the adrenal glands,
treatment requires lifelong HORMONE THERAPYto pro-
vide adequate levels of cortisol and usually aldos-
terone as well. With treatment most people who
have Addison’s disease are able to enjoy normal
lifestyles and activities, though must remain vigi-
lant for indications of Addisonian crisis.
Addisonian Crisis (Adrenal Crisis)
Addisonian crisis, also called adrenal crisis, occurs
when physical stress such as injury, infection, or
illness increases the body’s demand for cortisol
beyond the capacity of the adrenal glands to pro-
duce. The body exhibits signs of SHOCKand cardio-
vascular shock, including extreme HYPOTENSION
(low BLOOD PRESSURE), DYSPNEA(shortness of breath
or difficulty BREATHING), and erratic HEART RATE.
Addisonian crisis is a life-threatening
event that requires immediate injection
of hydrocortisone and emergency med-
ical care.Prompt and appropriate medical intervention
(injected hydrocortisone and supportive measures
to sustain cardiovascular function) can restore
normal functions. However, Addisonian crisis can
quickly turn fatal. People who have Addison’s dis-
ease often carry emergency doses of injectable
hydrocortisone, with instructions for dosage, and
should wear identification of some sort (bracelet
or necklace) that identifies them as having Addi-
son’s disease so medical aid response can act
promptly with the correct measures.Symptoms and Diagnostic Path
One of the earliest, though nonspecific, symptoms
of Addison’s disease is craving salt and salty foods,
which occurs because the aldosterone deficit
allows the KIDNEYSto release excessive amounts of
sodium into the URINE. Other symptoms also tend
to be nonspecific and include- fatigue and tiredness
- postural hypotension (drop in blood pressure
when rising from a sitting position) - loss of APPETITEand weight loss
- MUSCLEweakness
- hyperpigmentation (darkening of the SKIN)
- irritability
- irregular MENSTRUATION(women)
The diagnostic path includes blood tests to
measure the amounts of potassium, sodium, GLU-
COSE, cortisol, and ADRENOCORTICOTROPIC HORMONE
(ACTH). Other tests typically include a cortisol chal-
lenge—ACTH stimulation and CORTICOTROPIN-
RELEASING HORMONE (CRH) stimulation tests—to
assess the body’s ability to produce cortisol and
diagnostic imaging procedures such as MAGNETIC
RESONANCE IMAGING(MRI) to visualize the hypothal-
amus, pituitary gland, or adrenal glands.DISTINGUISHING FEATURES OF ADDISON’S DISEASE
AND ADRENAL INSUFFICIENCY
Addison’s Disease Adrenal Insufficiency
normal ADRENOCORTICOTROPIC low ACTH
HORMONE(ACTH) normal SKINcolor
areas of HYPERPIGMENTATION normal blood potassium level
elevated BLOODpotassium normal blood sodium level
level (HYPERKALEMIA) normal blood glucose level
low blood sodium level normal aldosterone
(HYPONATREMIA) production
low blood GLUCOSElevel
(HYPOGLYCEMIA)
deficient ALDOSTERONE
production106 The Endocrine System