It can affect people of any age, although it's most common between the ages of 30 and It's also more common in women than men. Early-stage symptoms of Addison's disease are similar to other more common health conditions, such as depression or flu. Over time, these problems may become more severe and you may experience further symptoms, such as dizziness, fainting , cramps and exhaustion.
You may also develop small areas of darkened skin, or darkened lips or gums. Although these symptoms are not always caused by Addison's disease, you should see a GP so they can be investigated. The condition is usually the result of a problem with the immune system, which causes it to attack the outer layer of the adrenal gland the adrenal cortex , disrupting the production of the steroid hormones aldosterone and cortisol. Other potential causes include conditions that can damage the adrenal glands, such as tuberculosis TB , although this is uncommon in the UK.
Addison's disease is treated with medication to replace the missing hormones. You'll need to take the medication for the rest of your life. With treatment, symptoms of Addison's disease can largely be controlled. Bergthorsdottir and co-workers found that the overall impact of concomitant diabetes on the excess mortality is minimal The contribution from diabetes to death in our study was 4.
At the time of diagnosis, and before the start of treatment for Addison's disease, the patients can be critically ill with increased risk of death 15 , 16 , 17 , The compensating mechanisms of young people are more prone to keep them circulatory stable until they eventually collapse with a crisis; older patients may call for medical assistance at an earlier stage.
One might speculate that young individuals are particularly ignorant to alarm symptoms, but most likely older people with adrenal insufficiency also die undiagnosed. We identified six patients who were diagnosed with adrenal insufficiency post-mortem, which is probably an underestimation.
In , Mason et al. Sudden deaths are not commonly found in hospital records; these deaths are investigated by police authorities and recorded correctly in the Death Cause Registry only if a medico-legal autopsy is performed. For the whole group of patients, our study shows that the prognosis is good. Patients with Addison's disease are seen regularly by their doctors, who may diagnose and treat other potentially lethal diseases.
The other main causes of death in our cohort, that is, cardiovascular disease and cancer, were equally or less frequent than that found in the general population. Thus, our results contrast the analyses of the Swedish National Hospital registry that showed a mortality rate twice as high as normal 11 , The recent analysis by Bensing and co-workers, however, showed that the cancer rates remained increased only in APS-1 patients, when tumors observed during the first year of follow-up were excluded.
In the APS-2 group, most likely to represent true autoimmune Addison's disease, cancer incidence rates were not increased Norway and Sweden have comparable health care systems that point to study design as the cause of differences in results.
The strength of the Swedish study is the number of observed patient years, whereas the comparative strength of our study is the verification of the diagnosis in all the patients and their true age at diagnosis. We included patients only after verification of the diagnosis by an endocrinologist reading the medical records.
This quality check revealed that the coding was surprisingly erroneous, which renders pure registry studies at jeopardy. Bergthorsdottir and co-workers report less than 8. In our experience, adrenal failure is particularly associated with erroneous coding since there are several forms primary, secondary, iatrogenic, congenital adrenal hyperplasia, and other that are easily mixed up. Our study also revealed that some patients who were assessed with suspicion of adrenal insufficiency were coded as such even if subsequent work-up turned out negative, causing much of the miscoding error.
Thus, scrutiny of medical records of every patient was crucial for obtaining high quality data in Norway. However, the age distribution of that sub-population 37 years was much lower than in the total population identified in the registry 53 years , indicating that the results of the quality check might not apply to the whole population. Furthermore, the Swedish study by Bergthorsdottir et al.
We believe that the SMR calculation is more correct when all the years from diagnosis until death or censure are taken into account. We suggest that the Swedish study overestimated SMR due to too liberal inclusion of patients at higher age who possibly were miscoded as adrenal insufficiency.
In conclusion, Addison's disease that presented before the age of 40 was associated with excess mortality due to acute adrenal failure, infections, and sudden death, particularly in men.
Improved patient education and doctor alertness are important to reduce these untimely fatalities. The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
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Just in time. New England Journal of Medicine ; : 46 — Addison's disease. If untreated, an Addisonian crisis can be fatal.
It may be caused by:. Not all symptoms occur on all occasions, but nausea, fatigue and dizziness are common early symptoms. If you experience symptoms of Addisonian crisis, call for an ambulance or go immediately to the emergency department of your nearest hospital. You will need emergency treatment, including intravenous fluids, increased steroid medication and saline.
Blood tests may show low sodium, high potassium or low glucose. Note: even if you use a hydrocortisone injection for Addisonian crisis, you will still need hospitalisation and ongoing monitoring.
Treatment aims to correct the levels of hormones that your body is not producing. Whether you have primary or secondary adrenal insufficiency, you will need hormone replacement for life. Cortisol is replaced orally with hydrocortisone tablets, taken once or twice a day. If you are also deficient in aldosterone, it is replaced with oral doses of a mineralocorticoid called fludrocortisone acetate, taken once a day.
Treatment needs to be tailored to each person as adrenal hormone replacement requirements vary between individuals.
Your doctor will advise you on how to reduce the risk of Addisonian crisis, including how to adjust your medication if your body is stressed for example due to an operation or illness and how to use injectable hydrocortisone if you are vomiting and unable to keep down oral medications. They will also advise you on how to let emergency medical personnel know what kind of care you need.
This may include:. This page has been produced in consultation with and approved by:. There is generally no cure for an autoimmune disorder, but the symptoms can be managed. Myalgic encephalomyelitis, commonly known as chronic fatigue syndrome, can affect people of any age, including children.
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