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Acute Adrenocortical Insufficiency

Acute Adrenocortical Insufficiency

What is Addison's disease? — Addison's disease is a condition that can cause people to have low blood pressure, lose weight, and feel tired and weak.
Addison's disease occurs when the body's adrenal glands do not work normally. The adrenal glands are small organs that are located on top of each kidney (figure 1). Normally, the adrenal glands make substances called hormones. These hormones do many things in the body, such as help keep blood sugar levels and blood pressure normal. In people with Addison's disease, the adrenal glands do not work properly and do not make enough hormones. This causes symptoms, which in some cases can become severe and even life-threatening.
What are the symptoms of Addison's disease? — Most people with Addison's disease have the following symptoms:
Feeling tired or weak
Weight loss and loss of appetite
Other common symptoms can include:
Darkening of the skin, especially on the face, neck, and back of the hands
Nausea and vomiting
Feeling light-headed or dizzy when standing or sitting up
Muscle and joint pain
Craving salt
Losing hair from the armpits and pubic area (in women)
Sometimes, a person's symptoms can become severe and life-threatening. Doctors call this "adrenal crisis." Symptoms of adrenal crisis can include:
Fever and weakness
Nausea, vomiting, and stomach pain
Passing out, or going into shock
Adrenal crisis usually happens when a person's body is under stress, such as from an infection or injury. It can also happen if a person has not been taking their medicine regularly.
Is there a test for Addison's disease? — Yes. Your doctor or nurse might order different tests to check for Addison's disease. These involve checking your cortisol levels, which can be done with a blood test. Cortisol is an important hormone that the adrenal glands normally make. In people with Addison's disease, the glands don't make enough of it.
Sometimes your doctor or nurse will give you a hormone shot, then measure the cortisol level in your blood 30 or 60 minutes later.
How is Addison's disease treated? — Addison's disease is treated with hormone medicines to replace the hormones that are missing in the body. People usually need 2 different medicines, which must be taken every day for the rest of their life.
It is important to let your doctor or nurse know if you have any side effects from the medicines or develop any new symptoms.
Your doctor might also prescribe emergency medicine that you should keep with you at all times in case you have adrenal crisis. This medicine comes in the form of a shot. If you think you are having adrenal crisis, use the medicine and then call for an ambulance (in the US and Canada, dial 9-1-1). Your doctor might recommend that you also use this emergency medicine if you:
Have a major injury, for example if you break a bone or lose a lot of blood
Pass out
Vomit up your daily medicine
What if I get sick or know that I am going to have surgery? — If you get sick or know that you are going to have surgery, talk with your doctor or nurse. For example, if you are vomiting and unable to keep your medicines down, let your doctor or nurse know. When people are sick or have surgery, their body might need more adrenal hormones than usual. Your doctor or nurse will tell you if you need to increase your medicines, and how and when to do it.
What if I want to get pregnant? — If you want to get pregnant, talk with your doctor or nurse. Most women with Addison's disease are able to get pregnant and have a baby. But your doctor will want to follow you closely. He or she might make changes in your medicine dose during the pregnancy.
What will my life be like? — Most people with Addison's disease lead an active and normal life. But to stay as healthy as possible, you can:
Follow your doctor's instructions about treatment
Carry an emergency medicine shot with you, especially if you travel to areas that are not near a hospital
Learn about the symptoms of adrenal crisis so that you will know when to treat it or get help
Wear a medical alert bracelet, and carry an emergency medical card
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 15599 Version 9.0
Release: 28.2.2 - C28.105
© 2020 UpToDate, Inc. and/or its affiliates. All rights reserved.

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