Causes and symptoms of Addison's disease
Addison's disease (bronze disease, chronicadrenocortical insufficiency) - a painful condition of the adrenal cortex that occurs during their bilateral lesions, resulting in a decrease (or eliminate) the secretion of adrenal hormones.
Addison's disease occurs when a lesion90% of adrenal tissue. In most cases, the cause of the disease - an autoimmune process (attack its own immune system), followed in frequency should be tuberculosis. As a syndrome, chronic adrenal insufficiency is present at a variety of inherited diseases.
Causes of Addison's disease:
- autoimmune lesion of the adrenal cortex (the immune system attacks its own)
- tuberculosis of the adrenal glands.
- removal of the adrenal glands
- the effects of long-term hormone therapy
- fungal infections (histoplasmosis, blastomycosis, coccidioidomycosis)
- bleeding into the adrenal glands
- Acquired immunodeficiency syndrome (AIDS)
Addison's disease is accompanied by an increased leveladrenocorticotropic hormone (ACTH), together with the alpha-melanocyte stimulating hormone, causes darkening of the skin and mucous membranes - the hallmark of Addison's disease, and therefore it is also called bronze.
Secondary insufficiency of the adrenal cortex gland failure due to brain - the pituitary gland; Unlike primary never accompanied by skin darkening.
The manifestations of Addison's disease are made up of signs of inadequate allocation of adrenal hormones. The predominance of certain manifestations determined by the duration of the disease.
- Darkening of the skin and mucous membranes (forprimary failure) often for months or years ahead of other manifestations. The simultaneous presence of vitiligo is due to autoimmune destruction of melanocytes - cells responsible for skin color.
- Extreme weakness (especially muscle), fatigue, weight loss, poor appetite.
- Reduced blood pressure, which is accompanied by vertigo. Also due to low blood pressure patients reported poor cold tolerance.
- Signs lesions of the gastrointestinal tract: nausea, vomiting, diarrhea episodic.
- There are mental disorders (depression, psychosis).
- Strengthening the taste, olfactory, auditory sensitivity; you may receive an irresistible desire to salty food.
The adrenal (adrenal) crises: they are based on a sudden deficiency of adrenal hormones due to increasing demand for them, or a sudden decrease in their production against the background of already existing chronic adrenal insufficiency.
Causes of adrenal crisis:
- Stress: acute infectious disease, trauma, surgery, emotional stress and other stress factors; adrenal crises in these situations provoke a lack of adequate increasing doses of hormone replacement therapy.
- Bilateral adrenal hemorrhage.
- Bilateral adrenal artery embolism or thrombosis of the adrenal veins (eg, during the X-ray contrast studies).
- Removal of the adrenal glands without adequate replacement therapy.
Manifestations of adrenal crisis: lowering blood pressure, abdominal pain, vomiting and impaired consciousness.
Diagnosis and treatment of Addison's disease
Diagnosis of Addison's disease is carried outendocrinologist and is reduced to identifying insufficient functionality of the adrenal cortex (to increase the synthesis of the hormone cortisol in response to a stimulating effect).
Treatment of Addison's disease:
- Diet for Addison's disease: a sufficient amount of protein, fat, carbohydrates and vitamins, especially C and B (recommend a decoction of rose hips, black currants, brewer's yeast). Table salt consumed in large amounts (20 g / day). The diet of potato reduced the content of peas, beans, beans, dried fruits, coffee, cocoa, chocolate, nuts, mushrooms. Vegetables, meat, fish should be consumed in cooked form. Diet fractional before bedtime recommend a light dinner (glass of milk).
- Treatment of Addison's disease - replacementadrenal hormone therapy. Apply hydrocortisone and fludrocortisone. Hydrocortisone 10 mg in the morning and 5 mg orally every day after dinner (adults up to 20-30 mg / day). Fludrocortisone at 0.1-0.2 mg orally 1 time a day. When blood pressure increase the dose should be reduced. In acute disease (such as a cold) or after a minor trauma double dose of hormones until feeling better. When surgical treatment before and (if necessary) after the surgery correcting the dose of hormones. In diseases of the liver, as well as elderly patients doses should be reduced.
- Treatment of adrenal crisis: It shows the urgent hospitalization. Intravenously injected 0.9% sodium chloride solution to eliminate dehydration, hydrocortisone. Clinical improvement (estimated primarily on restoring blood pressure) usually occurs within 4-6 hours after intravenous therapy.
- At higher temperatures (in the background of normal blood pressure) prescribe antipyretics, such as paracetamol.
- When surgery is necessary to correct the dose of steroid hormones.
- Avoid infections.
With adequate treatment of Addison's disease prognosis. Life expectancy is close to normal.