Addison's Disease[edit | edit source]Addison’s disease is another name for primary chronic adrenal insufficiency. It is a condition where the adrenal cortex (the outer layer of the adrenal gland that produces mineralocorticoids, glucocorticoids, and androgens) is progressively destroyed, resulting in decreased secretions of hormones.[1][2] Cortisol, a glucocorticoid, and aldosterone, a mineralocorticoid, are the hormones that are affected by Addision's disease causing a global metabolic disorders and fluid imbalance.[1]In the developed world, Addison's disease is most commonly caused by autoimmune disease however worldwide, tuberculosis is the most common cause. Show
Adrenal insufficiency may also be caused by long-term administration of corticosteroids or disorders of the hypothalamus or pituitary gland, but this is not Addison's disease.[3] Clinically Relevant Anatomy[edit | edit source]The adrenal (suprarenal) glands are endocrine glands that are located superior to the kidneys. The adrenal glands have two layers the adrenal cortex (the outer layer) that is responsible for producing steroid hormones and the inner layer the medulla which is responsible for secreting the hormones that control our stress response, commonly referred to as our fight or flight response[4] The Adrenal Cortex[edit | edit source]The adrenal cortex is the outer layer of the gland and is divided into three zones:
Total loss of the steroid hormones secreted by the outer layer results in death due to dehydration and electrolyte imbalance. Unless corrected by hormone replacdement therapy death will usually occur within weeks, sometimes within a few days.[4] The Adrenal Medulla[edit | edit source]The inner zone of the adrenal glands are responsible for producing catecholamine. These are hormones such as epinephrine (adrenaline) and norepinephrine (noradrenaline) and small amounts of dopamine whose function is to initiate a rapid response to stressful situations.[4] Prevalence[edit | edit source]Addison’s disease occurs in about 1 in 100,000 Americans[5]. About 8,400 people are currently diagnosed with Addison's disease in the UK[3]. Even though it is seen throughout the lifespan in both genders, it most commonly occurs in middle-aged white females. Characteristics/Clinical Presentation[edit | edit source]Addison’s disease will develop insidiously, with the signs of the disease not developing “until at least 90% of both glands is destroyed and the levels of circulating glucocorticoids and mineralocorticoids are significantly decreased.”[2] Some of the clinical signs and symptoms of Addison’s disease include:
Addison's disease should also be considered in a person with persistent, non-specific symptoms, such as:
The possibility of Addison's disease should also be considered in people with:
Associated Co-Morbidities[edit | edit source]Addison's disease can occur alone, or it can occur along with other autoimmune disorders, leading to polyendocrine syndrome[7].
Osteoporosis is more common among people with Addison's disease compared to healthy individuals because of the medical management with long-term steroid replacement therapy. Steroids have several effects on bones including increasing osteoclastic activity, decreasing osteoblastic formation, and decreasing the absorption of calcium in the intestines.[8]
Medications[edit | edit source]
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
Test Results That Suggest Addison's Disease[10]
[Chart courtesy of Merck.com. Available at http://merck.com/mmpe/sec12/ch253/ch253b.html] Causes[edit | edit source]There are a number of causes for Addison’s disease, the most common causes are autoimmune adrenalitis, infectious adrenalitis from disease such as tuberculosis, the acquired immune deficiency syndrome (AIDS), syphilis or adrenal metastases such as lung, stomach, breast or colon cancer.[11] About 70% of cases in the US and UK are due to idiopathic atrophy of the adrenal cortex, probably caused by autoimmune processes[10][7] Adrenal Crisis[edit | edit source]Adrenal Crisis is rare but should not be overlooked. When in crisis, the patient with Addison's disease the adrenal glands gradually stop producing enough cortisol to supply the body. Cortisol is involved with many body systems and this condition can result in threat to life. Signs of Adrenal Crisis include:
If left untreated, symptoms of shock, fever and convulsions may follow. An adrenal crisis is a medical emergency.[7] Physical Therapy Management[edit | edit source]There is very little information and research pertaining to the physical therapy management of patients with Addison's disease. Jakobi et al[12] found that women with Addison's disease had a similar maximum voluntary force of the quadriceps muscle compared to the control group of healthy individuals, however, they had "altered contractile properties and decreased endurance compared with controls." Obviously, more research needs to be performed to determine the proper interventions that physical therapists should utilize to treat patient's with Addison's disease and also determine any limitations to treating these patients. Therapist are equipped in helping people to overcome some of their symptoms prior to diagnosis to allow them to return to all levels of activities, such as:
Differential Diagnosis[edit | edit source]
Resources[edit | edit source]The Canadian Addison Society National Endocrine and Metabolic Diseases Information Service Addison's Disease Self-Help Group References[edit | edit source]
Which signs symptoms should the nurse expect to note when collecting data on a client with Addison's disease?Signs and symptoms may include:. Extreme fatigue.. Weight loss and decreased appetite.. Darkening of your skin (hyperpigmentation). Low blood pressure, even fainting.. Salt craving.. Low blood sugar (hypoglycemia). Nausea, diarrhea or vomiting (gastrointestinal symptoms). Abdominal pain.. What were your first symptoms of Addison's disease?Initial symptoms of Addison's disease can include:. fatigue (lack of energy or motivation). lethargy (abnormal drowsiness or tiredness). muscle weakness.. low mood (mild depression) or irritability.. loss of appetite and unintentional weight loss.. the need to urinate frequently.. increased thirst.. craving for salty foods.. Which symptom would the nurse assess in a client with a diagnosis of Addison's disease?Symptoms of Addison's disease include: Steadily worsening fatigue (most common symptom). Patches of dark skin (hyperpigmentation), especially around scars and skin creases and on your gums. Abdominal pain.
Which of the following findings would be typical of Addison's disease?These may include unexplained fatigue, poor appetite, chronic abdominal pain, or weight loss. Hyponatremia with or without hyperkalemia and/or hypotension can often be seen in Addison disease. Addisonian crisis is often manifested by severe dehydration, confusion, refractory hypotension, and shock.
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