Addison's Disease
Investigating Addison's Disease
Etiology, Symptoms, Diagnosis, Treatment, Prevention
Metabolism - A term used to describe a chemical process within living bodies that convert readily avaliable macro/micro nurtients into energy (ATP) through catabolism (breaking down of molecules such as carbohydrates into glucose), and is heavily influenced by hormones.
Metastatic cancer - A condition in which infectious cancer cells are able to migrate to another place in the body, different from their origin point.
Hemorrhage - When a blood vessel gets damaged, a loss of blood can occur internally. This causes someone to bleed profousely from the inside and leaves them open to infection.
X-Linked disorder - Refers to the instance in which a genetic condition is passed down through the mother's X chromosome to their sons, primairly. This occurs because of the X chromosomes larger carrying capacity. Daughters can be affected as well, but it is less likely due to the Barr Bodies concept in biology (females have double the chance to recieve a healthy X chromosome).
Introduction
The endocrine system is a collection endocrine and exocrine glands which perform certain tasks within the body to maintain homeostasis.
One such gland are the adrenal glands, located on the top of the kidneys. These glands produce an abundance of hormones that each serve their own purpose in the body.
These hormones include Aldosterone (regulates blood pressure), cortisol (regulate blood sugar and metabolism), and androgens (produce male sex hormones). If the balance of any of these hormones are disturbed, the body's homeostasis is affected causing a possible physiological condition within the body.
Etiology:
Addison's Disease is marked by an insufficiency of the hormones produced by the adrenal glands. These hormones, speciafically cortisol, play a massive role in regulating metabolism within the body.
Consequently, a patient presenting with Addison's Disease has an etiology affecting the Adrenal glands.
There are a number of reasons as to why the adrenal glands may fail to produce cortisol. The most common and direct cause can be an autoimmune disorder, adrenaltitis, in which the body's immune system attacks the cells and tissues of the adrenal glands, negatveily affecting its function. This is an X-linked disorder and is passed down from mother to son.
However Addison's disease can manifest through outside factors without the need of genetics:
Infection
Almost any type of outside infection that can cause the death of cells, can cause harm to other parts of the body. A number of infectious diseases such as HIV, tuberulosis (historically common) and fungual infections are known to harm the adrenal glands, and as such run the risk of Addison's disease.
Hemorrhage
Bleeding from within the body is never a good sign. This indcates internal injury and can lead to bacterial infections, blood clots, etc. These or the loss of blood, can affect the adrenal glands, preventing the production of the adrenal hormones, causing Addison's disease. It is important to note that a hemorrhage is usually caused by an unrelated factor and hormone insufficency is mostly a byproduct.
Cancer
Cancer is known for its ability to spread throught the body the longer it is allowed to replicate. In metastasis cancer, there is always a chance it might spread to the kidneys, and by extension, the adrenal glands. When this happens, the cancer begins to kill the cells responsible for the production of the adrenal gland homrones, causing a insufficency in adrenal hormones.
Medications
The kidneys act as a filtering system for the human body. Medications often end up in the kidney system and are later removed with urine and urea once the body has absored its properties. Some medications (Megestrol, Ketoconazole, mitotane, etc.) place a heavy burden on the kidneys in the long term, suppressing the efficency of the adrenal glands.
Symptoms:
Due to the nature of Addison's disease, most of the symptoms are in response to the body's attempt to reinstate homeostasis or a direct consequences of a failing metabolism. These symptoms are gradual and often can be mistaken for other conditions or habits.
Low Blood Sugar and Pressure
Once adrenal gland hormones fail to be produced, it is much more difficult for the body to convert stored/incoming nutrients into energy (cortisol) and regulate blood pressure (aldosterone). This means less sugar is able to be found within the blood being transported to the cells and blood pressure grows weak, respectfully. This causes weakness, fainting, and fatigue as the body has a hard time delivering neccesary nutrients. Other symptoms include the sudden craving for salt. As aldosterone is produced less and blood pressure lowers, the body might compenstate by wanting more sodium within the blood to encourage more water into the bloodstream.
Weight Loss and Muscle Weakness
As the patient grows weaker, their appetite slows, and causes weight loss as a byproduct. Often gastrointentinal issues can occur as the body attemps to grapple with the metabolism issues caused by the hyposecretion (low secretion) of adrenal hormones, causing vomiting. Freqeunt vomiting causes further weight loss. Muscle weakness can also occur as hypoglycaemia (low blood pressure) leads to not enough muscle cells receiving nurtirents. This causes the muscles to weaken and become slower in repair and efficency.
Diagnosis:
ACTH Readings
Adrenocorticotropic hormone (ACTH) is a hormone released by the hypo-pituiatry gland in the brain. It's released when the body detects low levels of adrenal gland hormones through a negative feedback loop. It causes an increase of adrenal glands. For the test, ACTH can be artifically injected to see if there is any increase in adrenal hormones. If there is not, it points towards the adrenal glands being damaged and unable to carry out their function.
The ACTH levels can also be measured individually as there is more ACTH in the body of a patient naturally as the body attempts to compensate by signalling the body to produce more hormones.
Blood Test
Through their blood, the hormones of a patient can be analyzed and measured. If the adrenal gland hormones have a low reading, this is a key sign for Addison's disease
MRIs
Imaging technology such as MRI's (magnetic resosnance imaging) can be used to see if there are any physical abnormalities (cancer, infection) in the adrenal glands that's impacting their function.
Treatment:
There are two main ways to treat Addison's disease, tackle the issues of hormone insufficency by helping the body compensate or treating the seperate condition that causes Addison's disease by extension.
Hormone Replacement Therapy
With the advancments of pharmacology, it is possible to simply replace any missing hormones. Since Addison's disease is categorized by the lack of adrenal gland hormones, it is possible to combat through the use of medications and/or injections. The doses filled with the neccesary homrones, corticosteroids and mineralocorticoids (cortisol and aldesterone), are carried throughout the bloodstream and the body uses them in order to return to homeostasis. These doses are all dependant on the individual's needs and require constant monitoring.
Lifestyle changes
If Addison's disease is not being caused by something genetic like an autoimmune disorder, then there are steps that a patient can take to slow the progression and/or prevent the disease.
By maintaining a health lifestyle by having a good diet, excersing, staying away from substances (alcohol, drugs), and managing stress, secondary Addison's disease can be treated and prevented.
Prevention:
The most common causes of Addison's disease is genetic and hereditary, meaning that it is not preventable.
But in cases where Addison's disease is a byproduct of another condition (infection, hemmorage, cancer, medication), the best form of prevention is standard.
As disscused before in the treatment section, maintaing a good, healthy lifestyle is the best way to ensure the kidneys and adrenal glands are in optimal condition.
Any other conditions not so easily prevented (cancers, medications) should be managed and monitored by medical professionals to limit their affects on the adrenal glands.