ADDISON'S DISEASE The adrenal glands, small bodies sitting
astride the kidneys, are essential to life because of the important
hormones-adrenaline, hydrocortisone, aldosterone, and many others-they secrete.
Any disease process that attacks the adrenal glands may produce a serious
problem-adrenal insufficiency or Addison's disease. Years ago most cases of
Addison's disease stemmed from invasion of the adrenals by tuberculosis. Now
the majority are due to shrinkage and withering away of the gland (atrophy)
with- out known cause.
Tuberculosis still causes some cases. In a very few in- stances, metastatic cancer, syphilis, or fungal infection is the cause. A patient with Addison's disease is weak, tires easily, has nausea and vomiting with generally poor appetite, and usually experiences bouts of diarrhea. The patient is irritable and has fainting spells. The skin turns dark and the dark color is especially prominent in body creases, over the but- tocks, in the nipples, and in any recent scars. Black freckles may appear on the tongue. The doctor finds low blood pressure, small heart, scant hair in armpits and pubic area. Laboratory tests show low blood concentration, reduced concentration of sodium in the blood, and reduced levels of ad- renal corticoid hormones.
Tuberculosis still causes some cases. In a very few in- stances, metastatic cancer, syphilis, or fungal infection is the cause. A patient with Addison's disease is weak, tires easily, has nausea and vomiting with generally poor appetite, and usually experiences bouts of diarrhea. The patient is irritable and has fainting spells. The skin turns dark and the dark color is especially prominent in body creases, over the but- tocks, in the nipples, and in any recent scars. Black freckles may appear on the tongue. The doctor finds low blood pressure, small heart, scant hair in armpits and pubic area. Laboratory tests show low blood concentration, reduced concentration of sodium in the blood, and reduced levels of ad- renal corticoid hormones.
Before modern replacement therapy for missing hormones
became avail- able, Addison patients had a grim out- look, usually dying within
a few years or even months. Now the outlook for them is decidedly favorable.
With expert medical treatment and their own wholehearted cooperation, many can
lead essentially normal lives. Cortisone or cortisol is the keystone of
therapy. The hormone is administered by mouth.
To help raise the abnormally low level of sodium in blood, large amounts of salt may be used or a corticosteroid hormone, DOCA, may be given since it helps regulate salt exchange. Addison patients do well on a diet high in protein and carbohydrate, especially if they take many small meals a day rather than the usual three larger ones. Addison patients must still guard against infections and any unusually severe stresses such as prolonged swimming in cold water.
To help raise the abnormally low level of sodium in blood, large amounts of salt may be used or a corticosteroid hormone, DOCA, may be given since it helps regulate salt exchange. Addison patients do well on a diet high in protein and carbohydrate, especially if they take many small meals a day rather than the usual three larger ones. Addison patients must still guard against infections and any unusually severe stresses such as prolonged swimming in cold water.
They need careful attention during pregnancy and surgery. An
Addison patient needs to discuss stress hazards thoroughly with his physician
just as a diabetic, 514 / Disease Scenarios through discussion with his
physician, learns what he needs to know about his disease. For example, an
Addison patient who understands his tendency to lose too much salt from the
blood will be careful after profuse sweating to replace losses. Since most
cases now involve atrophy of the adrenal cortex from unknown cause, primary
prevention is not yet possible.
For the tubercular type of Addison's disease, primary prevention, of course, is the same as for tuberculosis (page 659). Secondary prevention, too, in a case resulting from tuberculosis requires intensive treatment of the tuberculosis.
For the tubercular type of Addison's disease, primary prevention, of course, is the same as for tuberculosis (page 659). Secondary prevention, too, in a case resulting from tuberculosis requires intensive treatment of the tuberculosis.
