Addison's Disease

Addison's disease (also known as chronic adrenal insufficiency, or hypocortisolism) is a rare endocrine disorder, first described by British physician Thomas Addison.

It is estimated that it affects about 1 to 2 in 100,000 people.

It occurs when the adrenal glands, seated above the kidneys, fail to produce enough of the hormone cortisol and, sometimes, the hormone aldosterone.

Addison's disease refers specifically to primary adrenal insufficiency, in which the adrenal glands themselves malfunction; secondary adrenal insufficiency occurs when the pituitary gland does not produce enough adrenocorticotropic hormone (ACTH) to adequately stimulate the adrenal glands.

Early signs

Addison's disease progresses slowly, and symptoms may not present or be noticed until some stressful illness or situation occurs. Common symptoms are:

• Chronic fatigue that gradually worsens
• Muscle weakness
• Loss of appetite
• Weight loss
• Nausea/vomiting
• Diarrhea
• Low blood pressure that falls further when standing (orthostatic hypotension)
• Areas of hyperpigmentation (darkened skin), known as melasma suprarenale.
• Irritability
• Depression
• Craving for salt and salty foods
• Hypoglycemia (worse in children)
• For women, menstrual periods that become irregular or cease
• Tetany (particularly after drinking milk) due to phosphate excess
• Numbness of the extremities, sometimes with paralysis, due to potassium excess

Treatment

Treatment for Addison's disease involves replacing the missing cortisol and, if necessary, fludrocortisone as replacement for the missing aldosterone. Caution must be exercised when the person with Addison's disease has surgery or becomes pregnant.

Famous patients

A famous sufferer of Addison's Disease was President John F. Kennedy. Jane Austen is thought to have been another (however it was not recognised as Addison's disease at the time she is thought to have suffered from it).