Addison's disease drugs. Addison's disease: symptoms and features of the clinical picture

Addison's disease or bronze disease is a pathological lesion of the adrenal cortex. As a result, the secretion of adrenal hormones decreases. Addison's disease can affect both men and women. The main risk group is people in the age group of 20–40 years. Addison's disease is characterized as a progressive disease with a severe clinical picture.

Etiology

In Addison's disease, the work of the adrenal cortex is disrupted. At this point in medicine, there is no exact etiology of the disease. But, as medical practice shows, the following can be provoking factors:

• autoimmune damage to the adrenal cortex;
• severe infectious and viral diseases (most often);
• oncological diseases (cancerous tumors);
• insufficiency of the adrenal cortex;
• wrong treatment.

As for tumors and insufficiency, such factors are quite rare in medical practice. According to statistics, the total number of patients is no more than 3%.

In 70% of cases, the provoking factor for the development of Addison's disease is a severe infectious or viral disease. Most often it is tuberculosis.

Addison's disease (bronze disease) is characterized by a fairly rapid development. The initial stage quickly turns into a chronic one and relapse is not ruled out. Depending on the degree of damage and developmental features, primary and secondary forms are distinguished.

Pathogenesis

The above etiological factors lead to complete or partial atrophy of the adrenal cortex. As a result, the production of essential hormones - corticosteroid and aldosterone - is sharply reduced. As a result of this, gastrointestinal ailments can form, of cardio-vascular system and general malfunctions of the body.

General symptoms

Since the hormones produced by the adrenal cortex affect the metabolism in the body, the symptoms of the disease are quite diverse. This makes the diagnosis somewhat more difficult. It is difficult to make a diagnosis based on the symptoms alone.

In the early stages of the development of Addison's disease, the following symptoms are observed:

• skin is pale, dry;
• the skin on the hands loses its elasticity;
• low blood pressure;
• disturbances in the work of the heart;
• diseases of the gastrointestinal tract are formed;
• neurological disorders.

There are also more specific symptoms in women and men.

In men, insufficient testosterone production affects intimate life. Sexual desire is significantly reduced. In some cases it is possible.

In women, the symptoms are more pronounced:

• menstruation stops;
• in the pubic area and armpits, hair growth stops.

It is worth noting that such symptoms in women (especially with regard to menstrual cycle) may indicate other disorders of the genitourinary system. Therefore, you need to contact a competent specialist for an accurate diagnosis.

From the gastrointestinal tract, not only symptoms in the form of diarrhea and nausea can be observed, but also the occurrence of other background diseases. Most often these are such ailments:

In addition to the above symptoms, the patient may have changes in the work of the central nervous system. This is due to the fact that with Addison's disease, the water-salt balance is disturbed and dehydration occurs. As a result, the following clinical picture is observed:

• numbness of the fingertips, sensitivity worsens;
• numbness of the legs and arms;
• muscle weakness;
• reflexes deteriorate.

At the same time, it also changes appearance a sick person - he looks very tired.

The manifestation of such clinical picture depends on general condition patient and the degree of development of Addison's disease.

Diagnostics

Diagnosis for suspected Addison's disease is carried out through laboratory, instrumental tests. The anamnesis and general condition of the patient, his lifestyle are also taken into account.

Diagnosis via laboratory tests includes the following:

• test samples for the production of hormones.

Instrumental diagnostic methods in this case are as follows:

Only based on the results complex diagnostics the doctor can confirm or refute the diagnosis.

Treatment

If Addison's disease is diagnosed on early stage treatment will not only significantly improve the patient's condition, but also avoid serious complications.

Except drug treatment The patient should follow a special diet. The main course of treatment is replacement therapy. In view of this, drugs of the following spectrum of action are prescribed:

• glucocorticosteroids;
• mineralocorticosteroids.

Also, the treatment program provides for the restoration of water-salt balance. To do this, the patient is injected intravenously with saline sodium chloride. If observed reduced content in the blood glucose, then a 5% glucose solution is prescribed intravenously.

The dosage and procedure for taking drugs is prescribed only by the attending physician. Self-medication is unacceptable.

If the disease is caused by an underlying infectious disease, then the course of treatment includes drugs to eliminate it. In this case, the endocrinologist conducts treatment together with a phthisiatrician or infectious disease specialist.

Diet

In addition to drug treatment, you need to follow a special diet. Potassium-rich foods should be eliminated or minimized.

The following foods should be present in the daily diet of the patient:

• apples, citrus;
• food with B vitamins (liver, carrots, egg yolk);
• foods that are rich in minerals, fats, carbohydrates.

Alcohol is completely excluded. In the patient's body, it is very important to maintain an optimal metabolism and prevent weight loss (if there is no excess weight).

Such complex treatment will significantly improve the patient's condition, relieve symptoms and prevent the development of complications.

Possible Complications

Most often, patients may develop another underlying disease. Most often it is chronic insufficiency of the adrenal cortex. It is worth noting that the secondary form of this disease can occur outside of Addison's disease.

Chronic insufficiency of the adrenal cortex in terms of symptoms is very similar to bronze disease:

• craving for salty foods (due to a violation of the water-salt balance);
• violations in the digestive tract;
• apathy, irritability;
• impaired memory, concentration;
• sudden weight loss.

Diagnosis is carried out through laboratory and instrumental tests:

• general analysis of blood and urine;
• blood chemistry;
• hormonal tests;

Based on the results obtained, the endocrinologist prescribes treatment.

Forecast

With timely treatment, the disease proceeds without significant complications and does not affect life expectancy. Patients with such an ailment are strictly prohibited from physical and emotional stress.

Prevention

Preventive measures are aimed at general strengthening of the immune system, prevention of infectious and viral diseases.

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Diseases with similar symptoms:

Diabetes is a chronic disease in which work is subject to damage endocrine system. Diabetes mellitus, the symptoms of which are based on a prolonged increase in the concentration of glucose in the blood and on the processes accompanying an altered state of metabolism, develops, in particular, due to a lack of insulin, a hormone produced by the pancreas, due to which the body regulates the processing of glucose in body tissues and in his cells.

Addison's disease, also called primary or chronic adrenal insufficiency or hypocortisolism, is a type of endocrine disorder that affects about one in 100,000 people. Addison's disease, the recommendations for the treatment of which we will consider in the article, has symptoms such as weight loss, muscle weakness, fatigue, low blood pressure and digestive problems.

It is believed that Addison's disease is usually autoimmune in nature and is the result of disorders of the adrenal glands that cause low level cortisol. About 70% of reported cases of Addison's disease are believed to be caused by autoimmune diseases in which the immune system produces high levels of antibodies to destroy the adrenal glands.

Although Addison's disease is a rare disease, recent evidence suggests that its prevalence is increasing. Women develop Addison's disease more often than men, and the disease is most common in people between the ages of 30 and 50, but people of all ages can be affected.

What is Addison's disease

Addison's disease is another name for a condition called diabetes that occurs when the adrenal glands don't produce high enough levels of several important hormones, including cortisol and sometimes aldosterone.

The adrenal glands are located just above the kidneys and play an important role in the production of adrenaline-like hormones and corticosteroids (also called "stress hormones"), which perform many functions, both during acute stress and in everyday life. These hormones are essential for maintaining homeostasis and for sending "instructions" to organs and tissues throughout the body. Hormones affected by Addison's disease include glucocorticoids (such as cortisol), mineralocorticoids (including aldosterone), and androgens ("male" sex hormones).

What does Addison's disease do to the body? Because some key hormones that normally regulate functions such as converting nutrients into energy, regulating sleep and wake cycles, electrolyte balance, sex drive, fluid retention, and body weight are missing, symptoms can be noticeable. They include chronic fatigue, changes in weight and appetite, depression, digestive problems, low blood pressure, and others. Although this condition can be life-threatening in some cases, traditionally the symptoms of adrenal insufficiency disappear with hormone replacement therapy.

Primary and secondary adrenal insufficiency

There are two main classifications of adrenal diseases. Also called "primary adrenal insufficiency," Addison's disease is caused by diseases of the adrenal glands themselves, including adrenal cancer, infections, or bleeding. Primary adrenal insufficiency is diagnosed when about 90% of the adrenal cortex has been destroyed. This type is less common and usually causes physical damage to the adrenal glands that can be detected.

The second group of adrenal diseases is called "secondary adrenal insufficiency", which is much more common. These types are stress related and autoimmune in nature. They develop despite the absence of physical disease in the adrenal glands. However, they can still cause severe hormonal imbalances and symptoms. People with secondary adrenal insufficiency usually do not experience skin changes (hyperpigmentation), severe dehydration, or low blood pressure, but are more likely to have low blood sugar.

Symptoms of Addison's disease

Related articles:

• Chronic fatigue (lasting more than a couple of weeks)
• muscle weakness
• Changes in appetite (more often loss of appetite)
• Weight loss
• Digestive problems (including abdominal pain, nausea, vomiting, diarrhea)
• Low blood pressure
• Dizziness or fainting
• Mood changes, irritability and depression
• Headache
• Cravings for salty foods
• Low blood sugar (hypoglycemia)
• Trouble sleeping, leading to constant feeling of tiredness
• General sweating and night sweats
• Irregular periods or amenorrhea
• low libido
• Joint pain
• Hair loss

Acute symptoms of adrenal insufficiency (Addison's crisis)

A rare and severe form of acute adrenal insufficiency called an adrenal crisis (or Addison's disease crisis) can sometimes occur.

This usually occurs after a traumatic life experience or physical injury, which puts even more stress on the adrenal glands and worsens the symptoms. This leads to a decrease blood pressure, lowering blood sugar levels and increasing blood potassium levels.

Severe adrenal insufficiency is caused by insufficient levels of cortisol, possibly because a case of milder adrenal insufficiency was not initially treated. This condition is life-threatening and must be treated by professionals immediately, so it is important to contact the department immediately emergency care if symptoms appear.

According to National Institute US Health, symptoms of an adrenal crisis include:

• Abdominal pain, nausea and vomiting
• confusion or coma
• Dehydration
• Loss of consciousness, dizziness or delirium
• Fatigue and weakness
• Headache
• Heat
• Loss of appetite
• Low blood pressure
• Fast heart rate
• Joint pain and slow, sluggish movements
• Unusual and excessive sweating
• craving for salt

Causes of Addison's disease

What is the most common cause of Addison's disease? Causes of Addison's disease usually involve some type of damage to the adrenal glands. The adrenal glands lose their ability to adequately respond to the stimulating hormone adrenocorticotropin (ACTH) produced by the pituitary gland. The complex system in the body called the hypothalamic-pituitary-adrenal axis no longer functions to send and receive signals that regulate hormone production.

In developed countries, autoimmune reactions commonly cause damage to the adrenal glands and Addison's disease. An autoimmune reaction is when your immune system starts attacking its own healthy tissue because it mistakenly suspects that the body is being attacked by harmful organisms. Many people with Addison's disease also have other types of autoimmune diseases.

Certain medications, genetic factors, surgeries, diseases, and serious infections can also cause problems with the adrenal glands when secondary adrenal insufficiency develops. Research has shown that around the world possible reasons include infections and viruses such as sepsis, tuberculosis, and HIV that affect the adrenal glands, as well as bilateral adrenal hemorrhages and neoplastic processes ( ).

Although autoimmune reactions are the most common cause of Addison's disease, factors that can worsen the condition and contribute to adrenal damage or autoimmune reactions may include:

• High levels of stress or a very stressful experience (such as a death in the family or a major life change).
• Exposure to toxins and environmental pollution.
• Lack of sleep and constant pressure on yourself despite feeling tired.
• Poor nutrition (including those that cause allergies).
• Overtraining/overtraining or lack of exercise
• Genetic Factors… One type of adrenal insufficiency is congenital adrenal hyperplasia, which is genetic. This type is rare, affecting only one in every 10,000 to 18,000 children, and is caused by a lack of certain enzymes necessary for the adrenal glands to produce hormones, resulting in high androgen production.

Some medications can also negatively affect the adrenal glands. Adrenal insufficiency can develop when a person who has been taking glucocorticoid hormones (such as prednisone) for a long time, which act like cortisol, suddenly stops taking these medications. If you have any prescriptions for treatment inflammatory diseases, such as rheumatoid arthritis, asthma or ulcerative colitis talk to your doctor about how to properly adjust your dosage before changing them yourself as they can lower ACTH and cortisol.

Diagnosis of Addison's disease and traditional treatment

Addison's disease is incurable and is considered chronic disease which can last for years or a lifetime.

The diagnosis of Addison's disease is based on test results, which may include a physical examination, blood tests, and urine tests that can check levels of ACTH, cortisol, and other factors. Addison's diagnosis is often delayed. Studies show that about 60% of patients visited two or more clinicians before Addison's diagnosis was considered, sometimes because the condition was confused with other disorders such as others. autoimmune conditions or disease thyroid gland(). And about half of patients with Addison's syndrome are diagnosed only after the onset of an acute adrenal crisis.

Standard diagnosis for Addison's disease, traditional medicine recommendations:

• The ACTH stimulation test is the most commonly used and involves an injection of synthetic ACTH along with testing for blood and urine responses to changes in cortisol levels. Even with the introduction of ACTH in people with adrenal insufficiency, there is little or no increase in cortisol.
• The CRH stimulation test can also help determine the cause of adrenal insufficiency and includes blood sampling before and 30, 60, 90, and 120 minutes after ACTH injection.
• Blood tests (such as the insulin-induced hypoglycemia test) can also detect low blood sodium, low blood glucose, and high blood potassium, which are sometimes seen in people with adrenal problems.
• A blood test can also be used to detect antibodies, proteins produced by the immune system that are associated with autoimmune diseases.
• CT ( CT scan) - used to check the size of the adrenal glands.

Determined that acute insufficiency adrenal is the leading cause of death, followed by infection. In this particular study average age of death for women (75.7 years) and men (64.8 years) was respectively 3.2 and 11.2 years less than the expected life expectancy of the population as a whole.

1. Eat enough salt

Addison's disease can lead to low levels of aldosterone, which increases the need for salt. According to the US National Institute of Diabetes and Digestive and Kidney Diseases, some people may benefit from a high-sodium diet. However, it's best to talk to your doctor or dietitian about how much sodium you should be consuming each day. If you need to increase your intake, try getting your sodium from healthy foods like broths, sea vegetables, and sea salt.

The need for salt (sodium) will also increase if you engage in heavy exercise, sweat a lot due to hot weather or gastrointestinal disorders that lead to vomiting or diarrhea.

2. Get Calcium and Vitamin D

Corticosteroid medications are associated with an increased risk of osteoporosis and loss of bone density. This means that getting enough calcium and vitamin D is critical to protecting bone health. Your doctor may also recommend that you take vitamin D3 and calcium supplements.

You can increase your calcium intake by eating foods high in this mineral, such as dairy products (raw milk, yogurt, kefir, and fermented cheeses), (cabbage and broccoli), sardines, beans, and almonds. The best way The natural way is to spend some time in the sun every day with exposed skin, for 10 to 20 minutes a day if possible.

3. Eat an Anti-Inflammatory Diet

Foods/drinks to limit or avoid to support your immune system include:

• Too much alcohol or caffeine, which interferes with your sleep cycle and can lead to anxiety or depression.
• Most sources of sugar and sweeteners (including high fructose corn syrup, packaged sugary foods, and refined grains).
• Processed foods and convenience foods as they are filled with many types of artificial ingredients, preservatives, sugar and sodium.
• Hydrogenated and refined vegetable oils (soybean, rapeseed, safflower, sunflower and corn).

Replace them with as much unrefined food as possible. Some of the best options for an anti-inflammatory diet include:

• natural, healthy fats(e.g. coconuts and Coconut oil, butter, avocado, nuts, seeds and olive oil).
• Lots of vegetables (especially whole leafy greens and cruciferous vegetables such as cauliflower, broccoli, Brussels sprouts, etc.).
• Wild-caught fish (such as salmon, mackerel, or sardines, which provide anti-inflammatory omega-3 fatty acids).
• High-quality animal products from grass-fed cows and chickens are grown on pastures, not in mills.
• Seaweed (high in iodine to support thyroid health).
• Celtic or Himalayan sea salt.
• High-fiber foods such as berries, chia seeds, flaxseeds, and starchy vegetables.
• Probiotic foods such as kombucha, sauerkraut, yogurt, and kefir
• Herbs and spices such as ginger, turmeric, parsley, etc.

4. Manage stress

Be sure to prioritize good sleep and quality rest, as lack of sleep means the adrenal glands have to produce additional stress hormones such as cortisol. Try to sleep between 8 and 10 hours a night depending on your specific needs.

While exercise that is gentle and enjoyable is important for overall health, be sure to rest when needed, ensure adequate muscle recovery, take rest days, and don't overwork yourself.

• Doing favorite hobbies.
• Meditation.
• Spiritual practices and prayer.
• Relaxing breathing techniques.
• Spend time outdoors, in the sun and in nature.
• Maintain a reasonable work schedule. Don't work at night!
• Eat regularly and avoid too a large number stimulants such as alcohol, sugar and caffeine.
• Feel free to seek professional help from a psychotherapist when dealing with major life events or traumas.

5. Take Supplements That Support Your Stress Response

Some supplements can help support your immune system and manage stress. Some examples:

• Medicinal mushrooms such as reishi and cordyceps.
• Adaptogenic herbs such as, and astragalus.
• Ginseng.
• (Glycinate or oxide is best for preventing diarrhea.)
• Taking a quality multivitamin that contains B vitamins, vitamin D, and calcium, as well as probiotic supplements, may also help maintain gut health and protect against nutritional deficiencies.

6. Avoid Complications

To prevent an emergency and reduce the risk of complications of adrenal insufficiency, people with Addison's disease should follow these guidelines:

• Visit an endocrinologist at least once a year.
• Annual screening for a range of autoimmune diseases.
• Carry a steroid ambulance card with you, medical kit for identification and a set for injections of glucocorticoids.

Precautions and side effects of treatment

Keep in mind that medication dosages may be adjusted from time to time based on factors such as stress and symptoms. For example, surgery, infection, or illness may mean that a higher dosage is needed to fight Addison's disease. It's important to check with your doctor if you notice an increase in symptoms or signs of an Addison's disease crisis, such as abdominal pain, confusion, sudden cravings for salt, dizziness, extreme fatigue, and weakness.

Addison's disease is a chronic insufficiency of the functioning of the adrenal cortex, manifested in a decrease or cessation of the secretion of hormones - mineralocorticoid and glucocorticoids ( , corticosterone , deoxycorticosterone and other corticosteroids).

The lack of mineralocorticoid hormones leads to an increase in sodium excretion and a decrease in potassium excretion, mainly with urine, but also with sweat and saliva, while electrolyte imbalance causes severe dehydration, plasma hypertonicity, a decrease in circulating blood volume, hypotension and even circulatory collapse . However, if the pathology is caused by reduced production, the electrolyte level remains normal or moderately altered. Whereas the lack of glucocorticoids causes such symptoms of Addison's disease: changes in sensitivity to and a violation of carbohydrate, protein and fat metabolism. As a result, the carbohydrates necessary for life are formed from proteins, the level of sugar in the blood decreases, and reserves are depleted. glycogen deposited in the liver, which is expressed in general, muscular, including myocardial weakness. In patients, resistance to viruses and infections, injuries and various types stress . In the process of development of insufficiency, cardiac output decreases, circulatory insufficiency occurs.

If the level of plasma cortisol is lowered, then there is a stimulation of ACTH synthesis and an increase in the level β-lipotropic hormone , which has melanocyte-stimulating activity, which together with tropin gives hyperpigmentation . People have not only bronze skin, but also mucous membranes. This means that the secondary insufficiency resulting from functional disorders pituitary, does not appear as hyperpigmentation.

This endocrine disorder occurs quite rarely - 4-6 people per 100 thousand in statistics different countries. It was first described by the English physician, father of endocrinology Thomas Addison back in 1855 in his book On the Constitutional and Local Consequences of Diseases of the Adrenal Cortex.

Pathogenesis

There are many mechanisms of damage to the adrenal cortex, causing insufficiency in the production of hormones - hypocorticism , or their complete absence acorticism . These include:

• autoimmune reactions (in 85% of cases) - antibodies to the adrenal cortex are synthesized in the body - M , lymphoid infiltration, fibrosis and atrophy of functioning glandular cells occur;
• infections - are brought into the adrenal glands hematogenously, most often provoke caseous necrosis and calcification;
• underdevelopment ( hypoplasia );
• oncology;
• genetic defects and diseases, such as hemochromatosis ;
• trauma;
• poisoning;
• disturbance of sensation or synthesis adrenocorticotropic hormone (ACTH) as a result of ischemia, radiation, etc.

Hormones of the adrenal cortex and their significance

Hormones produced in the morphofunctional adrenal cortex are corticosteroids . Among them, the most active and important are:

• Cortisol - a glucocorticoid synthesized in the fascicular zone of the cortical layer. Its main function is the regulation of carbohydrate metabolism, stimulation of gluconeogenesis and participation in the development of stress reactions. The conservation of energy resources is realized through the binding of cortisol to liver receptors and other target cells, which causes the activation of synthesis glucose , storing it in the form of glycogen against the background of a decrease in catabolic processes in the muscles.
• Cortisone - glucocorticoid, the second most important after cortisol, which is able to stimulate the synthesis of carbohydrates and proteins, inhibit the organs of the immune system, increase the body's resistance to stressful situations.
• Aldosterone - the main human mineralocorticoid, synthesized in the glomerular zone of the cortical thickness, under its action tissues are able to retain water, chlorides, sodium reabsorption, potassium excretion increase, a shift towards alkalosis occurs, blood pressure and circulating blood volumes increase.
• Corticosterone - a less significant mineralocorticoid hormone, also has glucocorticoid activity, although two times less than that of cortisol, which is realized mainly in the stimulation of liver gluconeogenesis.
• Desoxycorticosterone is a minor inactive mineralocorticosteroid hormone that can regulate water-salt metabolism, increase the strength and endurance of striated muscles.

Classification

Depending on the mechanism of development of Addison’s disease or in another way bronze disease, there are:

• primary insufficiency of the adrenal cortex - at the heart of the pathology is the defeat of the glandular structures directly;
• secondary insufficiency - as a result of a violation hypothalamic-pituitary system , which normally should stimulate the adrenal cortex.

Acute adrenal insufficiency is called hypoadrenal or Addisonian crisis.

Features of the Addisonian crisis

The Addisonian crisis develops suddenly and can threaten a person's life. Low concentrations of hormones (cortisol, aldosterone) in the bloodstream lead to loss of consciousness or psychosis, confusion, delirium , severe vomiting and , violations of mineral and water balance, pain in the legs, lower back, abdomen, lowering blood pressure and even cause shock .

The reasons

Addison's disease and adrenal hypofunction can develop as a result of such processes and pathologies as:

• tuberculosis, syphilitic, brucellosis;
• purulent inflammation;
• decreased sensitivity or insufficiency of ACTH;
• taking exogenous corticosteroids, which provokes atrophy of the adrenal glands;
• development of non-hormone-producing tumors;
• congenital dysfunction;
• amyloidosis ;
• drug therapy, such as chlodatin , etomidate , as well as barbiturates, blockers of steroidogenesis.

Symptoms of Addison's disease

The symptoms of Addison's disease are most acute under stress, when the sympathetic-adrenal system is depleted and the body experiences an increased need for glucocorticoids. Pathology develops slowly and may not be noticed for several months or even years, while it progresses, and the patient experiences:

• chronic fatigue;
• muscle weakness;
• increased irritability, anxiety, restlessness, tension and irascibility;
• depressive disorder;
• thirst and need for plenty of fluids;
• strong heartbeat and development;
• taste changes in favor of salty and sour;
• flushes of nausea, (disturbances in the act of swallowing), disorders digestive system- vomiting, diarrhea, abdominal pain;
• losing weight and losing appetite;
• dehydration and excessive urination ( polyuria );
• tetany, and convulsions , especially after consumption of dairy products and the resulting phosphates;
• and deterioration in the sensitivity of the limbs;
• decrease in glucose levels in the bloodstream hypoglycemia );
• decrease in the amount of circulating blood hypovolemia ).

In addition, arterial and quite often orthostatic hypotension develops. In women from the reproductive system, adrenal depletion causes menstrual cycle disruptions, in men it is observed.

Important! One of the most specific manifestations of the disease described by Addison is hyperpigmentation skin those areas that are exposed to solar radiation or more friction. dark spots – melasma occur throughout the body and even on the gums, so the pathology is also known as bronze disease. Only 10% of patients do not have this symptom and this pathology is called "White Addison" .

Another pathology is also known, described by Addison and manifested in the form of yellowness of the integument - Addison-Birmer anemia , develops with a deficiency and is also called differently pernicious anemia or malignant anemia .

Addison-Birmer disease: symptoms and features

At the heart of the pathology is atrophy of the gastric mucosa and cessation of secretion Castle factor . Most often occurs in the elderly and people over 40 years of age. In addition to the autoimmune mechanism, the cause may be , crayfish, helminthiasis, stomach resection and .

Symptoms of Addison-Birmer disease are reduced to burning of the tongue, sensitivity, dryness and inflammation of the mucous membranes, fatigue, , increased heartbeat, drowsiness during the day and at night. At the same time, dyspeptic disorders join -, diarrhea . Very often, patients seek medical care with significant anemia.

Analyzes and diagnostics

To confirm Addison's disease, you need to carry out:

• ultrasound examination of the adrenal glands to identify lesions, for example, with;
• a blood test to determine the level of adrenal hormones (cortisol), ACTH, glucose, potassium, sodium, ;
• CT of the adrenal glands, which allows you to detect adrenal infarction, size reduction, tumor metastases, amyloidosis;
• MRI of the brain to study the hypothalamic-pituitary region and detect destructive, tumor or granulomatous processes.

Basis for diagnosis Addisonian crisis is:

• a decrease in the sodium concentration in the bloodstream below 130 mmol / l, urinary excretion - less than 10 g per day;
• an increase in the concentration of potassium in the bloodstream over 5 mmol / l;
• drop in the ratio of sodium ions to potassium to 20 units (normally 32);
• low glucose levels;
• development of acidosis;
• high concentrations urea , residual nitrogen in blood plasma tests.

Treatment

The main treatment for primary hypocorticism is hormone replacement therapy . The lack of cortisol can be filled with hydrocortisone, and aldosterone - fludrocortisone acetate .

Procedures and operations

• Antipigmentation - subcutaneous injections of antioxidant cocktails and brightening drugs, for example, placenta extract , , linoleic , glycolic acid , multivitamin complexes, plant extracts.
• Photothermolysis or laser therapy - removal of pigmentation by destroying skin microfractions and pigment cells at the level of the epidermis. In the future, the restoration and renewal of the skin occurs when the processes of melanin synthesis in the body are normalized.

First Aid for Addison's Crisis

At the first manifestations of a decrease in the level of cortisol and aldosterone in the bloodstream, the patient needs:

• administer intravenously (if he is unable to take it orally);
• use saline (0.9% NaCl ) and .

Diet for adrenal insufficiency

In addition to the fact that the patient needs to avoid stressful situations, a diet rich in carbohydrates is recommended. In the diet, you need to add foods with an increased amount of ascorbic acid (blackcurrant, citrus fruits, rosehip broth) and an additional 15-20 g of salt per day.

To prevent hyperkalemia, it is better to limit the intake of potassium-rich dried apricots, raisins, legumes, potatoes.

Consequences and complications

Left untreated, bronze disease can lead to an Addisonian crisis, especially with infection, bleeding, injury, or surgery.

List of sources

• Lavin N. (ed.) Endocrinology 2nd ed. Per. from English. - M.: Practice, 1999. - S. 183-191.
• Dedov I.I., Marova E.I., Vaks. V.V. Adrenal insufficiency etiology, pathogenesis, clinic, diagnosis, treatment. Toolkit for doctors. Moscow 2000.

who have great importance in the regulation of metabolism, water-salt metabolism and other body functions. As a result, weight loss occurs, blood pressure decreases, muscle weakness and fatigue appear.

The disease develops as a result of damage to the cells of the adrenal cortex. This can occur with autoimmune processes (diseases in which the immune system damages the cells of its body, mistaking them for foreign ones), with various infectious diseases (for example, tuberculosis), adrenal tumors. As a result, the so-called primary insufficiency of the adrenal cortex occurs.

Secondary insufficiency develops with a lack of adrenocorticotropic hormone, which stimulates the activity of the adrenal cortex. This hormone is secreted by the pituitary gland (a structure in the brain that controls the activity of various organs that produce hormones).

Treatment consists of taking hormonal drugs to compensate for the missing hormones of the adrenal cortex.

Russian synonyms

Chronic insufficiency of the adrenal cortex, hypocorticism, "bronze" disease.

English synonyms

Adrenal insufficiency, hypocortisolism.

Symptoms

• General weakness, fatigue;
• muscle weakness;
• a decrease in blood pressure (moreover, when a person moves from a horizontal position to a vertical position, the pressure can decrease even more, causing fainting;
• darkening of the skin (most pronounced in places skin folds, in the area of ​​elbows, knees, fingers and toes, lips and mucous membranes);
• weight loss;
• cravings for salty foods;
• loss of appetite;
• pain in muscles, joints.

Also, with this disease, "Addisonian crisis" can occur - a serious condition that threatens life and requires urgent medical manipulations. It is accompanied by the following symptoms:

• sudden intense pain in the lower back, abdomen, and legs;
• vomiting and diarrhea;
• dehydration of the body;
• drop in blood pressure;
• loss of consciousness.

General information about the disease

Addison's disease results from insufficient secretion of hormones by the adrenal cortex. The adrenal glands are located at the top of the kidneys and consist of two layers: the adrenal cortex and the medulla. The cortex secretes steroid hormones: glucocorticoids (cortisol), mineralocorticoids (aldosterone), and androgens (male sex hormones). In stressful situations, hormones (for example, adrenaline) are produced in the medulla, which contribute to the mobilization of the body's forces.

The hormones of the adrenal cortex perform the following functions.

• Cortisol develops the body's reactions to stress, participates in the regulation of carbohydrate, protein, fat metabolism, maintains blood pressure, and has an anti-inflammatory effect. It is excreted from the body with urine and saliva.
• Aldosterone is involved in the regulation of water-salt balance, maintaining blood pressure. It ensures the retention of sodium by the kidneys and the excretion of potassium. Ultimately, this leads to the preservation of the necessary amount of water and salts for the normal functioning of the body. A decrease in aldosterone production leads to a decrease in the amount of fluid in the body and a drop in blood pressure.
• Androgens are male sex hormones. Produced by the adrenal glands in both male and female female body. In men, they are responsible for the appearance of secondary sexual characteristics (development of the genital organs, hair growth on the face, torso, etc.). In the male and female body, androgens affect the development of muscle mass, sexual desire.

Addison's disease is caused by damage to the adrenal cortex (primary adrenal insufficiency), which can occur for the following reasons:

• autoimmune diseases (the immune system detects and destroys foreign objects, such as pathogenic bacteria, but in some cases it begins to destroy the cells of its own body, so the adrenal cortex can be damaged);
• hereditary predisposition to autoimmune processes that can destroy the adrenal cortex;
• various infections that cause the death of cells of the adrenal cortex (for example, tuberculosis);
• adrenal tumors;
• hemorrhages in the adrenal glands.

There is also secondary adrenal insufficiency. The activity of the adrenal glands is controlled by the pituitary gland (a special structure in the brain). When the adrenal glands do not produce enough hormones, the pituitary gland produces adrenocorticotropic hormone (ACTH). That, in turn, stimulates the activity of the adrenal glands, causing an increase in the production of necessary hormones. With insufficient secretion of ACTH by the pituitary gland, secondary adrenal insufficiency occurs.

Usually the symptoms of the disease develop gradually. In case of injury, illness or other stressful effects, there may be an acute shortage of adrenal hormones. This condition is called an Addisonian crisis. It threatens the patient's life and requires urgent medical measures.

Who is at risk?

• Suffering from autoimmune diseases.
• People whose close relatives suffer from Addison's disease (with an autoimmune mechanism of development).
• Patients with tuberculosis.
• Patients with various infectious diseases(mostly fungal).

Diagnostics

Laboratory methods play a leading role in the diagnosis of Addison's disease.

• . Cortisol is a hormone of the adrenal cortex, which is involved in the regulation of metabolism, maintaining blood pressure, and developing the body's response to stress. In Addison's disease, its level is reduced.
• . Cortisol is excreted from the body in the urine, where it is in a free state, since it is not bound to blood proteins. Normally, its concentration increases in stressful situations, injuries, physical activity. In Addison's disease, the concentration of cortisol in the urine is reduced.

• . Aldosterone is a hormone secreted by the adrenal cortex. It regulates the water-salt balance in the body. In Addison's disease, the adrenal glands do not produce enough of it.
• . This hormone is secreted by the pituitary gland. With a decrease in the level of hormones of the adrenal cortex, it stimulates their production. In secondary adrenal insufficiency, the level of ACTH is reduced.
• ACTH test. Allows you to determine the function of the adrenal glands. For this, the level of cortisol in the blood is measured before and after the administration of adrenocorticotropic hormone. With normal adrenal function, cortisol levels will rise, as ACTH stimulates its production. If the adrenal glands are damaged, the level of cortisol (the hormone of the adrenal glands will not change).
• . These ions maintain the water balance in the body, are involved in the transmission of nerve impulses, and are necessary for muscle function. In Addison's disease, aldosterone production decreases, serum potassium levels increase, and sodium levels decrease. There is a violation of water-salt metabolism.

Other studies

• CT scan. A method that allows you to get layered images internal organs. Based on the action of X-rays. With the help of CT, it is possible to identify volumetric formations that may be the cause of dysfunction of the adrenal glands, to find out their size.
• Magnetic resonance imaging. A research method that allows you to get detailed layer-by-layer images of the internal organs of a person. At secondary insufficiency the adrenal cortex (it is associated with a malfunction of one of the structures of the brain - the pituitary gland) may require an MRI of the brain.

Treatment

The treatment of Addison's disease consists in taking hormonal drugs to correct the level of missing hormones (cortisol and aldosterone). With aldosterone deficiency, it is recommended to increase salt intake. Increasing the doses of drugs may be required for stressful effects on the body, such as injuries, operations, diseases.

Primary chronic adrenal insufficiency was first described by Thomas Addison in the middle of the 19th century. He identified the main signs of the disease: abdominal pain, heart palpitations, weakness, skin pigmentation. In another way, this pathology is also called hypocorticism, "bronze disease", Addison's syndrome. In the article, we will consider in detail what are the features of Addison's disease, the symptoms and causes of the disease, as well as the methods of its treatment.

Addison's disease: causes

Addison's disease is a rare disease. It occurs due to when both adrenal glands begin to produce an insufficient amount, in particular,.

The secretion of hormones may stop altogether. When more than 90% of the adrenal tissue is affected, this pathology is diagnosed. The development of the disease is facilitated by changes in the tissue of the adrenal cortex or pituitary gland.

The causes of the disease can be:

• Autoimmune adrenalitis.
• Tuberculosis.
• Histoplasmosis.
• neoplastic process.
• Hemochromatosis.
• Amyloidosis.
• Sarcoidosis.
• Hemorrhage in the adrenal glands.
• AIDS.
• Long-term treatment with hormonal drugs.
• Syphilis.
• Poisoning with toxic substances.
• Removal of the adrenal glands.
• hereditary factor.

The form of the disease can be primary (if only the adrenal cortex is affected) or secondary (if the pituitary gland is affected, as a result of which adrenocorticotropic hormone, which is responsible for the work of the adrenal cortex, is not produced).

Addison's disease: symptoms

The average age of patients with this disease is 40 years.

Its main symptoms:

• Hyperpigmentation of the skin upon contact with sunlight (observed in 90% of patients).
• Feeling weak and tired.
• Slow movements, quiet speech.
• Lack of appetite.
• Weight loss.
• Nausea, vomiting.
• Pain in the abdomen.
• Chair disorder.
• Decreased blood pressure (90/60 and below, occurs in 88-90% of patients).
• Paresthesia.
• Tremor (shaking) of the arms, legs or head.
• memory impairment, nervous disorders, depression.

Addison's disease in women, unlike men, is more severe. Often there are failures of the menstrual cycle, amenorrhea. Under medical supervision in women suffering from Addison's syndrome, pregnancy and childbirth are possible.

Dangerous is the Addisonian crisis. Its signs may be:

• Severe pain in the lower part of the body.
• Vomit.
• Diarrhea.
• A sharp drop in blood pressure.
• Disturbance of consciousness or its loss.

With this condition of the disease, immediate medical attention is needed.

Addison's disease in children

Toddlers in early age this pathology is extremely rare. It can occur as a result of birth trauma (if there is a hemorrhage in the adrenal cortex), erythroblastosis or microcephaly.

In preschool children, Addison's disease can develop as a result of hypoplasia or atrophy of the adrenal glands, resulting from a malfunction of the hypothalamic-pituitary system and a decrease in the amount of corticotropin produced. This happens, for example, with long-term use of glycocorticoids in large doses.

In older children, this deficiency occurs with hematogenous disseminated tuberculosis. Often the disease progresses due to autoimmune lesions of the adrenal glands.

Addison's disease: diagnosis

Diagnosis chronic insufficiency The adrenal cortex is established by a doctor who takes into account the following indicators:

• clinical picture.
• The amount of hormones in the adrenal cortex and in the blood.
• general data, and biochemical analyzes blood.
• results general analysis urine.
• ECG indicators, as well as ultrasound, CT, MRI and radiography of the bones of the skull.

Timely contacting a medical facility will make it possible to make or clarify the diagnosis and start treatment on time.

Addison's disease: treatment

Patients suffering from "bronze disease" need a systematic intake of corticosteroids (glucocorticoids, sometimes mineralocorticoids).

The therapy is carried out with Hydrocortisone (Cortisol). This is the most common and effective drug, which is used in combination with other drugs:

• DOXA.
• Deoxycorticosterone trimethylacetate.
• Fluorohydrocortisone, etc.

Except replacement therapy adrenal hormones, patients are advised to consume an increased amount of vitamin C dietary salt.

At severe forms diseases require treatment in a hospital setting. Antibacterial and symptomatic therapy is prescribed according to indications.

Mode

Taking glucocorticoids makes it possible for people with Addison's syndrome to live an almost full life (before the use of hormones, the life expectancy of patients was less than six months).

However, you must follow these rules:

• Strictly follow the instructions of the doctor.
• Avoid heavy physical labor.
• Exclude the intake of alcoholic beverages, barbituric hypnotics, alkaline mineral waters.
• Always be ready necessary medicines for first aid.
• If symptoms of the disease appear, seek medical attention immediately.

Each patient receives a treatment plan leaflet from the health facility, indicating the schedule for taking medications and their dosage, as well as a leaflet for the health worker in case of an emergency if the patient cannot provide information about his illness himself.

Hypocorticism is a rare but very serious disease. And since it is impossible to completely overcome the disease, you need to rebuild your regimen, life and lifestyle, be patient and clearly follow all the instructions and recommendations of the attending physician.

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