Addison’s disease is also known as hypocortisolism or adrenal insufficiency. It is an endocrine disorder affecting the ability of the adrenal glands to produce sufficient steroid hormones cortisol, and in some cases, there is a production of low levels of aldosterone (Department of Human Services Association, 2014). Insufficiency of steroids and aldosterone has far reaching effects on the normal functioning of the human body.
Adrenal insufficiency is caused by some factors; the various causes are classified according to the manner in which they cause adrenal insufficiency. There are three broad categories, and they include impaired steroid genesis whereby the adrenal gland is fully formed but is not able to produce cortisol. The second classification is adrenal destruction caused by an autoimmune disease adenitis which attacks the adrenal gland wrecking it. The last category is adrenal dysgenesis a genetic disorder which involves various mutations during development hence a poorly developed renal organ that cannot be able to perform its endocrine functions.
The adrenal glands produce broad categories of hormones that have distinct roles in the body. Insufficiency of the gland leads to defects in each of the functions of the hormones. The hormones include Glucocorticoids whose primary purpose is to enhance the metabolism of carbohydrates and fats to produce energy, the hormones are also essential in the body’s response to stress, and one’s control once inflammatory response. Mineralocorticoids include aldosterone are necessary for the maintenance of the body’s electrolyte balance more so the potassium and sodium which are important for the regulation of the blood pressure. Lastly, androgens which are the sex hormones, promote sexual development in both women and men through influence libido, muscle mass as well as the sense of well-being.
Signs and symptoms
Patients who are suffering from Addison’s disease present with numerous signs and symptoms which are as a result of the impaired production and functioning of the hormones produced by the adrenal gland. The development of the signs and symptoms of Addison’s disease is gradual and in some cases can go unnoticed until the patient gets into Addison's crisis characterized by very small amounts of adrenal gland hormones. Some of the signs and symptoms include fevers, muscle weakness, diarrhea, sweating, fever, nausea, weight loss, fatigue, muscle and joint pains and changes in personality or mood. Due to the poor regulation of sodium, some patients end up to develop a craving for salt. Lastly, there are incidences of skin hyperpigmentation more so among people living in sunny places and are suffering from Addison’s disease (Agrawala, Sahoo, Choudhury, Mohanty, & Baliarsinha, 2013). On examination, the patients might present with orthostatic hypotension.
The Addison’s crisis is one of the major complications of Addison diseases. This condition sets in where there is a very severe adrenal insufficiency and can be life threatening through its manifestation hence needing medical emergency care. Patients with adrenal insufficiency present with, sudden penetrating pain in the abdomen, lower back and the legs, low blood pressure, hyperkalemia, hypernatremia, hypercalcemia convulsions, hypoglycemia, syncope among others.
Laboratory tests are important in the diagnosis of Addison’s disease. A blood test is done to check the levels of cortisol, potassium, and sodium and to determine the antibodies responsible for autoimmune reaction in patients suffering from Addison’s disease. Adrenocorticotropic hormone stimulation can be carried out to ascertain the functioning of the adrenal glands. The adrenocorticotropic hormone is usually responsible for the stimulation of the adrenal gland to produce the various hormones. The stimulation test also aids in establishing the type of Addison disease affecting the patient. Also, a thorough analysis of the stimulus provides information on the origin of the Addison disease which could be the hypothalamus, anterior pituitary gland or the adrenal gland itself. Lastly, imaging test can be done to establish abnormalities in the gland and the actual size of the gland. Through CT scans, it is easy for one to determine the extent to which the adrenal gland has been damaged in cases of autoimmune disorders.
Addison’s disease is a rare condition in the United States with a prevalence of about 50 people in a million. The case is the same internationally whereby in the United Kingdom the prevalence is 39 cases in one million inhabitants (Association, 2012). Mortality and morbidity from Addison’s disease is a rare case; it is usually a consequence of a late diagnosis and poor management of patients where some skip doses of synthetic mineral corticoid and glucocorticoid hormones. According to Heijnen, Pluijms, & Birkenhager, (2013), it is evident that even genetic Addison’s disease is not debilitating provided that the condition is discovered early and managed adequately. For instance, John f Kennedy, the president of the United States, was one of the prominent people living with Addison’s disease.
Pathophysiology and management
The development of the Addison disease is brought about by the inadequate hormonal supply to the system. Its primary pathophysiology is based on the causes of the disease. The primary goal of a nurse in the management of Addison disease is to prevent the effects of deficient hormones in the blood. To begin with, the care of the patient mostly is focused on ensuring that they are not dehydrated, electrolyte imbalance is corrected and sufficient cortisol. The nurse has to make sure that there is the fair administration of intravenous fluids, mostly 3000mls in a day to keep patients well rehydrated when in a crisis. This is because of the insufficient aldosterone in the system leads to excessive loss of fluids through urine.
Secondly electrolytes sodium and potassium are also during micturition. Sodium and potassium play a significant role not only in the regulation of blood pressure but also in the transmission of impulses and the activity of the heart muscle. Therefore these two minerals have to be kept within the normal ranges for a steady supply impulses and activity of the heart muscles. Synthetic cortisol can also be administered to facilitate the development of energy and other functions of cortisol. In most cases, Addison disease does not affect warranty and inpatient management not unless one is in a crisis. Most of the attacks are manageable in the emergency room if identified timely. Concisely, Addison’s disease can be fatal however it is easily manageable. Appropriate health education to the patients and timely intervention in a case of a crisis owing to its life-threatening nature.