Addison's Disease

Addison’s disease is the mirror image of Cushing’s syndrome, so why write about it in a Cushing’s blog?  In my case my cortisols swing so low I’m actually Addisonian for periods of time as evidenced by a presentation in an ER in a state of adrenal crisis and some labs I have documenting cortisols in that range.  I recently met two other folks in the same situation on Facebook so there are folks out there in the Cushie community for whom this is a relevant subject.  So let’s give it a whirl.

As I mentioned in the opening, Addison’s disease is the mirror image of Cushing’s syndrome and Cushing’s disease.  It is a condition where the cortisols are too low and is lethal if left untreated.  The pathology may be autoimmune disorders and it is often associated with them, trauma, or infection.  The symptoms may include:

·        Changes in blood pressure, generally a lowering of the blood pressure.

·        Chronic diarrhea, vomiting, nausea resulting in loss of appetite and weight loss.

·        Darkening of the skin in places causing a splotchy look.

·        Paleness

·        Extreme weakness fatigue and sluggishness.

·        Mouth lesions inside the cheek.

·        Salt craving.

·        The patient may also develop vitiligo, an abnormal whitening of the skin in patches.

The lab values associated with Addison’s are:

·        Abnormally low cortisols.

·        High potassium levels

·        Low sodium levels.

The victim of Addison’s disease may also suffer from autoimmune disorders such as Hashimoto’s disease and may also suffer from pernicious anemia.  Addison’s is also more common in frequency than Cushing’s.

Sufferers of Addison’s may also go into adrenal crisis, which I wrote about here:

Adrenal Crisis 

For the person whose cortisols swing both ways this means we get the worse of both worlds.  I have pernicious anemia and the compromise to bodily healing which takes place when the cortisols are so low makes my back situation even worse.  I also suffer from a very rare manifestation of Rheumatoid Arthritis, Recurring posterior scleritis, an autoimmune disease.  As I mentioned earlier I’ve had several bouts with adrenal crisis.  I do have a little tanning going on, but it’s mild and it is splotchy.

Those with Addison’s have to be very careful because their immune responses are compromised, so they need to contact their doctors in any of the following cases:

·        Infection.

·        Stress.

·        Injury.

·        Surgery.

Their medications may need adjusting.  It goes without saying that a cyclical Cushie or Addisonian with extreme cycles needs to do the same.

Although I did mention that Addisonians are more common than Cushies, they are rare as well.  Their situation is serious and they need all the help and support they can get from family and friends.  Just as with Cushing’s, family and significant ones should become familiar with the nature of the disease.  In the case of the extreme emergency which constitutes a crisis it is especially necessary for family, friends and coworkers to know the symptoms.

Addison's Disease at Wikipedia 

Addison's Disease at PubMed Health 

Adrenal Insufficiency

Hello again:

I’ve got my computer back and the programs I wanted on it for the most part.  So now I’m back to where I can start doing things again.  That being the case, sit back and let me tell you a little story, a true one.

It was February the eighteenth 2008.  I woke up about four in the morning feeling sick, very sick.  I ran to the bathroom and vomited, and then I had to take a dump which turned out to be so watery it was unbelievable.  Before I knew it I was sitting on the toilet defecating so hard my bladder was running and viciously vomiting at the same time.  My wife woke up to me gasping for help between the retching and rushed me to the hospital.

The triage nurse took me right on back into a treatment room where an IV was started and some medicine to calm the overwhelming nausea and pain I was experiencing.  I have the lab report from the ER that morning and know I was suffering from Adrenal Insufficiency, or AI and was undergoing an Adrenal Crisis.

Adrenal Insufficiency, or AI as it’s often called, occurs when the adrenal glands shut down production the hormones they produce.  When this happens it throws the electrolytes out of balance and the sodium drops and the potassium rises.  When this happens suddenly the symptoms often seen are:

·        Nausea and vomiting

·        Diarrhea

·        Acute stomach pain and cramps

·        Generalized cramping

·        Dizziness which increases upon standing  (due to low blood pressure which drops further on standing)

·        Disorientation leading to unconsciousness and coma

An adrenal crisis is a serious problem and can lead to death if untreated.  Although it is often considered a slow starter, I know of one post surgical Cushing’s sufferer whose boyfriend went out to run errands for a couple of hours and found her dead on his return.  So it’s serious business.  Unfortunately ER doctors don’t consider it so and won’t even test Cortisol levels even with the electrolyte results staring them in the face.  That was what happened to me that night.

Fortunately the treatment includes giving the patient fluids by IV, which was what the doctors did that night and patients in adrenal crises which are recognized are given Hydrocortisef, or cortisol, by injection.  Fortunately the treatment for dehydration along with the anti-nausea drugs were enough to stabilize the symptoms and I was sent home with a prescription for more anti-nausea medicine and an order to take in as much fluids as I could handle.

For many Cushies, AI and the possibility of an adrenal crisis is a very real danger.  The majority face it because of surgery.  Removing a tumor causing Cushing’s syndrome can cause the adrenals to temporarily shut down and precipitate a crisis.  Those who have to go on Hormone Replacement Therapy (HRT) because both adrenals have been removed live with the reality as well.  But a rare set of Cushies, cyclical Cushies with cycles which swing extremely low, may also face both.  So be aware of the possibilities my friends if you fall into any of those categories and make sure both you and those close to you know the symptoms.