Addison’s disease, also known as chronic adrenocortical insufficiency. It is caused by the destruction of adrenocortical tissue (at least more than 95%). Most of the causes are autoimmune and adrenal cortical tuberculosis, others are infection, inflammation, destructive tumor and adrenal amyloidosis. The main symptoms are lack of glucocorticoids and mineralocorticoids, such as muscle weakness, weakness, extreme fatigue, weak heartbeat, frequent nausea, vomiting, hypoglycemia, weight loss, decrease of blood Na +, increase of blood K +, water loss, low blood volume, hypotension, renal dysfunction and reduced resistance. In addition, there are characteristic skin and mucosal pigmentation. Pigmentation is most obvious in the friction of face, joint flexion and extension surface and skin wrinkles, as well as nipple, areola, genitalia, shoulder and axillary part, lower abdominal midline, finger (toe) nail root, etc. The pigment varies in depth, such as coking coal, brown yellow or bronze in light. The mechanism is that the loss of glucocorticoid feedback inhibition on the pituitary gland increases the release of adrenocorticotropic hormone (ACTH) and melanocyte stimulating hormone (MSH), and the first 13 amino acids of ACTH peptide chain are exactly the same as MSH, which can also promote melanin formation, and both cause pigmentation.
Addison’s disease, also known as primary chronic adrenocortical hypofunction, is caused by bilateral adrenal cortical atrophy, tuberculosis and other serious infections or tumors. Most of it is caused by insufficient secretion of adrenocortical hormone due to tuberculosis destroying the adrenal cortex or partial or total resection of bilateral adrenal cortex, It can also be secondary to the lack of CRH secretion by hypothalamus and ACTH secretion by pituitary, but it is often caused by adrenal gland itself. In addition, autoimmune diseases and severe mental trauma can also destroy or atrophy the adrenal cortex; The rest are amyloidosis, tumor, syphilis, fungi and thrombosis, which can also destroy the adrenal cortex and affect its function.
The disease is often insidious, and the first symptoms are gastrointestinal symptoms of unknown cause, such as anorexia, abdominal pain and diarrhea. Normal gastrointestinal peristalsis may be related to adrenocortical function to some extent, but the relationship between them is still unknown. In addition to gastrointestinal symptoms, it can also show weakness, weight loss, pigmentation and decreased blood pressure.
Most of the patients are middle-aged and young, mostly between 20 and 50 years old. The prevalence of men and women is almost the same, and the majority of patients with unknown causes are women.
After the strict use of endocrine therapy and anti tuberculosis treatment, the life of patients is greatly prolonged, the labor force is also significantly restored, and can be close to normal people. Follow up observation showed that some patients could have normal pregnancy and childbirth if they continued treatment for more than 7 years, but attention should be paid to the prevention and treatment of adrenal crisis during delivery. The growth and development of children before and after childbirth are completely normal. During the treatment, the patient has low resistance, is prone to respiratory tract infection, gastrointestinal dysfunction, and even lead to the attack of adrenal crisis, which should be paid attention to.
The skin manifestation of Addison’s disease is brownish black pigmentation on the skin and mucous membrane, which is most obvious in the parts of exposure, compression and friction, such as forehead, around the eyes, flexion of limbs, shoulder, axillary, waist, hip folds and palmoplantar dermatoglyphs. Brown pigment spots also appear on mucous membranes such as lips, buccal mucosa, gums, nipples, areola, external genitalia and so on. In addition to skin manifestations, the disease also has symptoms such as fatigue, mental atrophy, loss of appetite, dizziness, palpitation, decreased blood pressure, nausea, abdominal pain, memory loss, inability to concentrate, depression, irritability, etc. This disease is often accompanied by other endocrine disorders, such as hypoglycemia, hypothyroidism, sexual dysfunction and so on.
Laboratory examination showed that blood sodium decreased, blood potassium increased, and the ratio of blood sodium to blood potassium was less than 30. Serum chloride decreased and blood glucose decreased. X-ray showed calcification of adrenal gland.
In addition to treatment, we should eat more lean meat, milk, eggs and fresh vegetables, and eat more sodium salt.
Clinical manifestations are symptoms caused by cortisol deficiency:
General weakness, weakness and emaciation, pigmentation of skin and mucous membrane, obvious pigmentation of exposed parts of skin and joint folds, pigmentation of oral, lip, tongue and buccal mucous membrane, reduction of female pubic hair and axillary hair, and decline of male sexual function.
Severe cases can lead to adrenal crisis, which often occurs in response to infection, trauma, surgery, delivery, overwork, massive sweating or sudden interruption of treatment. It is characterized by nausea, vomiting, diarrhea, severe dehydration, decreased blood pressure, fast heart rhythm, weak pulse, often high fever, hypoglycemia, hyponatremia, etc., which can be life-threatening.
The diagnosis of Addison’s disease mainly depends on the determination of blood and urine cortisol and blood ACTH levels. Patients with definite diagnosis need life-long replacement treatment with adrenocortical hormone (pines), and they also need to increase in case of infection and other stress conditions.