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Addison’s Disease: 6 Ways to Manage Chronic Adrenal Insufficiency

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Addison's disease - Dr. Axe

Addison’s disease, also called primary or chronic adrenal insufficiency or hypocortisolism, is one type of endocrine disorder that affects about one in 100,000 people. Addison’s disease symptoms are usually prominent and include weight loss, muscle weakness, fatigue, low blood pressure and digestive issues.

It’s believed that Addison’s disease is usually autoimmune in nature and a result of adrenal impairments that cause low levels of cortisol. About 70 percent of reported cases of Addison’s disease are thought to be caused by autoimmune diseases in which the immune system makes high levels of antibodies to destroy the adrenal glands.

While Addison’s disease is a rare condition, recent data suggests an increasing prevalence. Women develop Addison’s disease more often than men, and this condition occurs most often in people between the ages of 30 and 50, however people of all ages can be affected.

What Is Addison’s Disease?

Addison’s disease is another name for the condition called chronic adrenal insufficiency, which occurs when someone’s 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 have the important role of producing adrenaline-like hormones and corticosteroids (also called “stress hormones”), which have many functions both in times of acute stress and also when someone is simply living everyday life. These hormones are needed to maintain homeostasis and to send “instructions” to organs and tissues throughout the body. Hormones that are 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 certain key hormones are missing that normally regulate functions like conversion of nutrients to energy, wakefulness, electrolyte balance, sex drive, fluid retention and body weight, symptoms can include chronic fatigue, changes in weight and appetite, depression, digestive issues, low blood pressure and others. While this condition can be life-threatening in some cases, usually symptoms are able to be managed with the help of hormone replacement therapy.

Primary Adrenal Insufficiency vs. Secondary Adrenal Insufficiency

There are two main classifications of adrenal disorders. Addison’s disease is also called “primary adrenal insufficiency“ and is caused by illnesses of the adrenal glands themselves, including adrenal cancer, infections or bleeding. Primary adrenal insufficiency is diagnosed when about 90 percent of the adrenal cortex has been destroyed. These types are less common and usually cause physical damage to the adrenal glands that can be detected.

The second group of adrenal disorders is called “secondary adrenal insufficiency,” which is much more common. These types are stress-related and autoimmune in nature. They develop despite no physical illnesses in the adrenal glands; however, they can still cause serious hormonal imbalances and symptoms. People with secondary adrenal insufficiency don’t typically experience skin changes (hyperpigmentation), severe dehydration or low blood pressure but are more likely to have low blood sugar.

Addison’s Disease Symptoms

The most common Addison’s disease symptoms include:

  • Chronic fatigue (lasting more than a couple of weeks)
  • Muscle weakness
  • Changes in appetite (especially a loss of appetite)
  • Weight loss
  • Digestive issues (including abdominal pain, nausea, vomiting, diarrhea)
  • Low blood pressure
  • Dizziness or fainting
  • Mood changes, irritability and depression
  • Headaches
  • Cravings for salty foods
  • Low blood sugar (hypoglycemia)
  • Trouble sleeping, which leads to always feeling tired
  • Sweating and night-sweating
  • Irregular periods or missed periods in women
  • Low libido
  • Joint pain
  • Hair loss

Acute Adrenal Failure Symptoms (Addisonian Crisis)

A rare and severe form of acute adrenal failure can sometimes occur that is referred to as adrenal crisis (or Addisonian/Addison disease crisis).

This tends to occur after a traumatic life experience or physical injury takes place, which places even more stress on the adrenals and worsens symptoms. It results in low blood pressure, low blood levels of sugar and high blood levels of potassium.

Severe adrenal insufficiency is caused by insufficient levels of cortisol, possibly due to not initially treating a case of milder adrenal insufficiency. This condition is life-threatening and must be treated immediately by professionals, so it’s important to go to the emergency room right away if symptoms show up.

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

  • Abdominal pain, nausea and vomiting
  • Confusion or coma
  • Dehydration
  • Loss of consciousness, dizziness or light-headedness
  • Fatigue and weakness
  • Headache
  • High fever
  • Loss of appetite
  • Low blood pressure
  • Rapid heart rate
  • Joint pain and slow, sluggish movement
  • Unusual and excessive sweating
  • Cravings for salt

Causes of Addison’s Disease

What is the most common cause of Addison disease? Addison’s disease causes usually include some type of damage to the adrenal glands. The adrenal glands lose the ability to adequately respond to a stimulating hormone called adrenocorticotropin (ACTH) produced by the pituitary gland. The intricate system in the body called the hypothalamus-pituitary-adrenal axis no longer functions to send and receive signals that govern hormone production.

In developed countries, autoimmune reactions are usually the cause of adrenal damage and Addison’s disease. An autoimmune reaction is when your immune system starts attacking its own healthy tissue because it mistakenly suspects the body is being attacked by a “foreign invader.” Many people with Addison’s disease also have other types of autoimmune disorders. Recent research suggests autoimmune disease reactions involved in Addison’s is multifactorial, involving variants in immune genes and environmental factors.

Certain medications, genetic factors, surgery, illnesses and serious infections can also cause adrenal problems like secondary adrenal insufficiency. Studies have found that worldwide, possible causes include infection and viruses such as sepsis, tuberculosis and HIV affect adrenal glands, along with bilateral adrenal hemorrhages and neoplastic processes.

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

  • High levels of stress, or a very stressful experience (like death in the family or major life change)
  • Exposure to environmental toxins and pollution
  • Lack of sleep and constantly pushing yourself despite feeling exhausted
  • Poor diet (including one that triggers allergies)
  • Over-exercising/overtraining, or a lack of exercise
  • Genetic factors … One type of adrenal insufficiency is Congenital Adrenal Hyperplasia (CAH), which is genetic and a condition that a baby is born with. This type is rare, affecting just one in every 10,000–18,000 babies and is caused by a lack of certain enzymes that the adrenal glands need to make hormones, resulting in high androgen production.

Some medications can also affect the adrenals in a negative way. Adrenal insufficiency can develop when a person taking glucocorticoid hormones (like prednisone) for a long time, which act similarly to cortisol, suddenly stops taking those medications. If you’re on any prescriptions for treating inflammatory illnesses like rheumatoid arthritis, asthma or ulcerative colitis, talk to your doctor about how to adjust your dosage appropriately before changing them yourself, since these can lower ACTH and cortisol.

Addison’s Disease Diagnosis and Conventional Treatment

Addison’s disease cannot be completely cured and is considered a chronic condition that can last for years or a lifetime.

An Addison’s disease diagnosis is based on results from tests that can include a physical exam, blood tests and urine tests, which can check for levels of ACTH, cortisol and other factors. A diagnosis of Addison’s is often delayed; studies show that about 60 percent of patients have seen two or more clinicians before a diagnosis of Addison’s is considered, sometimes because this condition is confused with other disorders, such as other autoimmune conditions or thyroid disorders. And around one-half of patients with Addison’s are only diagnosed after an acute adrenal crisis occurs.

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

Addison’s disease treatment almost always involves hormone replacement therapy, commonly using oral corticosteroids. Medications used to replace missing hormones include hydrocortisone (Cortef), prednisone or methylprednisolone to replace cortisol, and fludrocortisone acetate to replace aldosterone. During an emergency/crisis, intravenous injections of corticosteroids, saline solution or sugar (dextrose) may be needed.

What is the life expectancy of a person with Addison’s disease?

Until recently, life expectancy in Addison’s disease patients was considered normal. But according to a 2009 study published in the European Journal of Endocrinology, “Addison’s disease is still a potentially lethal condition, with excess mortality in acute adrenal failure, infection and sudden death in patients diagnosed at young age. Otherwise, the prognosis is excellent for patients with Addison’s disease.”

Acute adrenal failure has been found to be a major cause of death, followed by infection. In this particular study, the mean ages at death for females (75.7 years) and males (64.8 years) were 3.2 and 11.2 years less, respectively, than the estimated life expectancy for the general population.

Natural Remedies for Chronic Adrenal Insufficiency

1. Consume Enough Salt

Addison’s disease can result in low aldosterone levels, which increases the need for salt. According to The National Institute of Diabetes and Digestive and Kidney Diseases, some people can benefit from following a high-sodium diet; however, it’s best to get advice from your doctor or a dietitian regarding how much sodium is best for you to have each day. If you do need to increase your intake, try getting sodium from healthy foods such as broths, sea vegetables and sea salt.

Your need for salt (sodium) will also increase if you engage in heavy exercise, if you’re sweating a lot due to hot weather or if you have gastrointestinal upset that results in vomiting or diarrhea.

2. Get Plenty of Calcium and Vitamin D

Taking corticosteroid drugs has been linked to a higher risk of osteoporosis and loss of bone density, which means that consuming enough calcium and vitamin D is critical for protecting bone health. Your doctor may also recommend taking vitamin D3 and calcium supplements.

You can increase your intake of calcium by eating foods high in calcium like dairy products such as raw milk, yogurt, kefir and fermented cheeses, green vegetables such as kale and broccoli, sardines, beans and almonds. The best way to increase vitamin D levels naturally is to spend some time in the sun each day with your skin exposed, about 10 to 20 minutes most days if possible.

3. Eat An Anti-Inflammatory Diet

Foods/beverages to limit or avoid in order to support your immune system include:

  • Too much alcohol or caffeine, which interfere with your sleep cycle and can result in anxiety or depression
  • Most sources of sugar and sweeteners (including high-fructose corn syrup, packaged sweet products and refined grains)
  • As much packaged and processed foods as possible, since these are filled with many types of artificial ingredients, preservatives, sugars and sodium
  • Hydrogenated and refined vegetable oils (soybean, canola, safflower, sunflower and corn)

Replace these with as much whole, unrefined food as possible. Some of the best choices included in an anti-inflammatory diet include:

  • Natural, healthy fats (coconuts and coconut oil, butter, avocado, nuts, seeds and olive oil, for example)
  • Plenty of vegetables (especially all leafy greens and cruciferous veggies like cauliflower, broccoli, Brussels sprouts, etc.)
  • Wild-caught fish (such as salmon, mackerel or sardines that provide anti-inflammatory omega-3 fatty acids)
  • High-quality animal products that are grass-fed, pasture-raised and organic (eggs, beef, chicken and turkey, for example)
  • Sea vegetables like kelp and seaweed (high in iodine to support thyroid health)
  • Celtic or Himalayan sea salt
  • High-fiber foods like berries, chia seeds, flaxseeds and starchy veggies
  • Probiotic foods like kombucha, sauerkraut, yogurt and kefir
  • Herbs and spices like ginger, turmeric, parsley, etc.

4. Manage Stress

Be sure to prioritize good sleep and get plenty of quality rest, since a lack of sleep means the adrenal glands need to crank out extra stress hormones like cortisol. Aim for eight to 10 hours of sleep per night depending on your specific needs.

While exercising in a way that is gentle and enjoyable is important for overall health, be sure to give yourself rest when needed, allow for adequate muscle recovery, take rest days and don’t overexert yourself.

Other ways to help manage stress include:

  • Practicing hobbies or something fun every day
  • Meditation and healing prayer
  • Relaxing breathing techniques
  • Spending time outside, in the sunlight and in nature
  • Maintaining a consistent and reasonable work schedule
  • Eating on a regular schedule and avoiding too many stimulants, like alcohol, sugar and caffeine
  • Getting professional help when needed to deal with major life events or traumas

5. Consider Supplements That Support Your Stress Response

Certain supplements may be able to help support your immune system and help you cope with stress. Some examples include:

  • Medicinal mushrooms, such as reishi and cordyceps
  • Adaptogen herbs like ashwagandha, holy basil and astragalus
  • Ginseng
  • Magnesium (glycerate or oxide may be best to prevent diarrhea)
  • Omega-3 fatty acids
  • Taking a quality multivitamin that provides B vitamins, vitamin D and calcium as well as a probiotic supplement can also be supportive of gut health and defend against nutrient deficiencies

6. Take Steps To Prevent Complications

To help prevent an emergency and lower risk for adrenal crisis complications, it’s recommended that people with Addison’s disease:

  • Visit an endocrinology specialist at least once a year
  • Have an annual screening for a number of autoimmune diseases
  • Carry a steroid emergency card, medical alert identification kit and glucocorticoid injection kit with them

Precautions and Side Effects of Treatments

Keep in mind that medication dosages may need to be adjusted from time to time based on factors like stress and symptoms. For example, operation, an infection or an illness can mean a higher dosage is needed to manage Addison’s disease. It’s important to follow up with your doctor if you notice any increase in symptoms or signs of Addison’s disease crisis, such as abdominal pain, confusion, sudden salt cravings, dizziness and intense fatigue and weakness.

What happens if Addison’s disease is not treated?

If the condition progresses to adrenal crisis and is left untreated, people can suffer serious symptoms and even die suddenly, so this is a situation to take very seriously. Adrenal crisis intervention usually involves high dose steroid injections, fluids and electrolytes to help restore function of the adrenal and pituitary glands.

Final Thoughts

  • Addison’s disease is another name for the condition called chronic adrenal insufficiency, which occurs when someone’s adrenal glands don’t produce high enough levels of several important hormones, including cortisol and aldosterone.
  • Addison’s disease symptoms typically include fatigue, nausea, darkening of the skin, low blood pressure, dizziness and others.
  • The most common Addison’s disease cause is an autoimmune reaction that damages the adrenal glands. Factors that can worsen this condition include stress, a poor diet, illnesses or infections, trauma or operations.
  • Addison’s disease treatment involves taking hormones to replace those that are not being produced by the adrenal glands. Other natural remedies for Addison’s disease include consuming enough salt, managing stress, eating a supportive diet and taking supplements like adaptogens and certain vitamins.
Josh Axe

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