Addison's Disease Treatment by Ray Sahelian, M.D. Addison's Disease Symptom

Addison's disease or primary adrenal insufficiency is a rare disease usually caused by autoimmune destruction of the adrenal gland cortex. Those with Addison's disease have a deficiency of cortisol and aldosterone. These deficiencies are accompanied by adrenal androgen depletion.

Addison's disease, or primary adrenal insufficiency, results in glucocorticoid and mineralocorticoid deficiency. Orthostatic hypotension, fever, and hypoglycemia characterize acute adrenal crisis, whereas chronic primary adrenal insufficiency presents with a slower onset of of malaise, anorexia, diarrhea, weight loss, joint, and back pain. The cutaneous manifestations include darkening of the skin especially in sun-exposed areas and hyperpigmentation of the palmar creases, frictional surfaces, vermilion border, recent scars, genital skin, and oral mucosa.

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Addison's Disease Treatment
Treatment of Addison's disease involves replacement of the deficient hormones. The current Addison's Disease treatment is the replacement of glucocorticoids and mineralocorticoids, but the available drugs do not restore the normal diurnal variations in serum hormone levels. The clinical consequences of the uneven replacement therapy are largely unknown.

   Current recommended daily starting dose for hydrocortisone and cortisone acetate are 20 and 25 mg, respectively, divided into two or preferably three doses. The mineralocorticoid depletion could be treated with fludrocortisone 0.05 -  1.0 mg/day. Replacement of DHEA at 20 mg a day has been advocated in adrenal failure, but the evidence is still not fully clear.

Symptoms of Addison's Disease
Patients with Addison's disease have a gradual loss of cortisol and aldosterone secretion. Over time, this leads to symptoms of fatigue, a loss of appetite, some weight loss, and weak muscles. Another Addison's disease symptoms is low blood pressure. Blood pressure falls further when a patient is standing. This leads to symptoms of dizziness or lightheadedness. Another common Addison's disease symptom is nausea, sometimes with vomiting, and diarrhea. Psychological Addison's disease symptoms include irritability and depression. The increase in ACTH due to the loss of cortisol will usually produce a darkening of the skin that may look like an inappropriate tan on a person who feels very sick.
   Many patients with Addison's disease on standard replacement therapy complain of fatigue, weariness, and reduced stress tolerance. One particular concern has been negative effects on both bone metabolism due to over-replacement of glucocorticoids and androgen depletion.

Addison's Disease and Depression

Patients with adrenocortical insufficiency may be at increased risk of developing severe affective disorders. Conventional replacement therapy with hydrocortisone may not be sufficient to ensure the psychiatric well-being of these patients.

Adrenal Crisis
Acute adrenal insufficiency is a rare but life-threatening disorder that develops as a result of inadequate adrenal steroid production. Early diagnosis is key for effective and life-saving treatment of the affected patients. The main clinical features are non-specific, thus often leading to misdiagnosis and invasive diagnostic work up, in particular in patients with previously unknown disease. Adrenal crisis in patients with known chronic adrenal insufficiency is nowadays rare.

Addison's Disease Diagnosis

Synthetic adrenocorticotropin 1-24 at a dose of 250 mug works well as a dynamic test. Elevated plasma levels of adrenocorticotropin and renin confirm the diagnosis.

Addison's Disease questions

Q. How refreshing to find a well researched site written in plain english, congratulations. I hope you can please help me with some information. My husband has just been diagnosed with Addisons and related thyroid problems. i have read a study in the UK by Dr Eleanor Gurnell where DHEA supplementation greatly improved mood and energy levels in Addisons patients. Do you have any other information on DHEA and Addisons? The UK study used 50mg supplements, but your site suggests much smaller doses are effective and safer: would this apply if you have little or no naturally occurring DHEA in your system? Do you know of any other supplements useful in Addisons?
   A. As a general rule, in healthy older individuals, DHEA may not be needed more than 1 or 2 mg a few times a week. However, those who a clinical deficiency in adrenal hormones would certainly need more. Each case is different and the dosage of DHEA would depend on the clinical response. My preference with hormones is that one should take the lowest amount that works.
 

Q. Would pregnenolone help in Addison's disease?
     A. It's a good question, I don't know whether pregnenolone would be helpful, but it is worth asking your endocrinologist to look into it.
 

Q. I could find not mention of DHEA for individuals with Addison's Disease. I have had Addison's disease for 25 years and DHEA has made a tremendous improvement in my life.
   A. Thanks for the feedback.

Q. My question is regarding Dr. Sahelian's comment about Pregnenolone. He cautions against the use of routine supplementation. And I appreciate his cautions very much, especially since so many seem to use this supplement as a "fountain of youth". However he mentions that pregnenolone might be useful in cases of extreme adrenal problems. My question again is... does he mean by extreme adrenal problems only diseases such as Addison's, or might pregnenolone (in small doses of course) be useful in extreme cases of adrenal fatigue (as some physician's are now prescribing), short of Addison's?
   A. Some individuals may benefit from small amounts of pregnenolone used appropriately even if they do not suffer from a defined medical disease such as Addison's.

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