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Addisons Disease Medical Negligence
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Addison's disease occurs when the body makes insufficient quantities of adrenal hormones. It can be due to failure of the adrenal gland or failure of those hormones that regulate the adrenal gland. The adrenal gland fails to produce cortisol and possibly aldosterone-a hormone that affects electrolytes, particularly sodium and potassium. Addison's disease affects both sexes equally and occurs in young and old alike. It can be serious enough to kill the sufferer.
Addison's disease has a number of symptoms. The symptoms often develop slowly over several months. Sufferers often experience weight loss and poor appetite, muscle weakness, fatigue, skin darkening, fainting spells, low blood pressure, cravings for salt, nausea, vomiting or diarrhea, low blood sugar, emotional irritability and depression.
The signs and symptoms of Addison's disease can occur suddenly in some cases. In such cases, the individual suffers from an Addisonian crisis with the following signs and symptoms: low back, abdominal or leg pain; severe vomiting and diarrhea; severely low blood pressure; coma or loss of consciousness; a high potassium level.
The cause of Addison's disease is damage to the adrenal gland and the insufficient production of cortisol and aldosterone in the body. The adrenal glands are located above the kidneys and produce important bodily hormones. Only the cortex of the adrenal glands is affected. The medulla, which makes epinephrine and norepinephrine, is not generally affected by Addison's disease.
The cortex of the adrenal gland produces three types of hormones. These include glucocorticoids, mineralocorticoids and male sex hormones. In primary adrenal insufficiency, the cortex itself is damaged and doesn't make the necessary hormones. It is most often a result of an autoimmune disease in which antibodies are made against cortical cells in the adrenal gland. Other causes of adrenal gland problems are tuberculosis, infections of the adrenal glands, bleeding into the adrenal glands and spread of cancer to the adrenal glands.
You can have secondary adrenal insufficiency if the pituitary gland fails and does not produce enough ACTH or adrenocorticotropic hormone. This hormone stimulates the adrenal gland to make cortisol and its other hormones. The adrenal glands are not specifically damaged but do not receive the right signal in order to make cortisol. Because the adrenal glands are not damaged, it is called secondary adrenal insufficiency. Another cause of secondary adrenal insufficiency happens when people take corticosteroids for diseases like asthma or arthritis and abruptly stop taking the medication. The adrenal glands cannot take up making corticosteroids fast enough and Addison's disease can occur.
If the Addison's disease is not properly treated, you can get an Addisonian crisis. It can happen whenever you are in physical distress, have an infection or another illness.
In testing for Addison's disease, the doctor can do a blood test showing the levels of sodium, cortisol, ACTH and potassium. These will be abnormal if you have Addison's disease. Blood tests can also indicate the presence of adrenal autoantibodies. An ACTH stimulation test involves giving you ACTH and watching to see if the adrenal gland makes the hormones after being stimulated. It can differentiate between primary and secondary Addison's disease and is diagnostic for both diseases. Another test involves providing insulin to a person and then detecting the amount of sugar the body puts out. If you are healthy, the glucose level drops and the cortisol level rises.
A CT scan can show abnormalities of the adrenal glands that might indicate adrenal insufficiency. An MRI scan of the pituitary can show abnormalities of the pituitary gland consistent with pituitary insufficiency.
The treatment of Addison's disease is to replace the lost hormones seen in the condition. You can receive oral corticosteroids and Florinef, which replaces aldosterone. You may receive your corticosteroids by IV or IM as well. Androgen deficiency in women needs to be treated just as much as with men. Dehydroepiandrosterone is given to women. Men receive androgen replacement as well. Replacing androgens improves libido, well-being or sexual satisfaction. Patients with Addison's disease need to take in a lot of sodium so as to replace lost sodium from diarrhea, lack of absorption of sodium and loss of sodium in sweat.
If a person is in Addisonian crisis, the individual needs supportive care, as well as intravenous doses of cortisol, salt solution and sugar.