Case Study Unit 1:
Addison’s Disease and Adrenal Crisis
PHGY 230 McGraw
Dr. Thomas Addison first discovered the disease known as Addison’s disease, in London, 1855. At that particular time, the tuberculosis infection was the most common cause of adrenal insufficiency. It wasn’t until the middle of the twentieth century that tuberculosis was no longer the leading cause. Due to the discovery of effective antibiotics and vaccines developed in this century, Addison’s disease is now more commonly known as an autoimmune disease. Addison’s Disease is one of the most common non-thyroid autoimmune endocrine disorders. Every year, about 1 in 100,000 people in the United States are affected with this disease, and women and men are usually affected quite equally. It affects a person during various stages of their life, and can go unnoticed for quite some time. If it does happen to go unnoticed, Addisonian Crisis, also known as Adrenal Crisis, can be life-threatening. Adrenal Crisis usually occurs in approximately 8% of people that have been diagnosed with Addison’s disease. Accurate incidence and statistic reports for Addison’s disease and adrenal crisis in the United States are hard to find since many cases are underestimated or not reported at all. Since the symptoms of most autoimmune endocrine disorders can also be symptoms for many other disorders, sometimes it becomes even more difficult to distinguish the cause and try to find a cure.
Addison’s disease usually affects people during their late twenties and thirties, with many of these cases involving women. Less commonly it can be congenital in babies and also affect children. It can either occur as an “isolated” disorder, or as part of a “polyglandular endocrine” disorder. A polyglandular endocrine disorder tends to occur together with other diseases, and affects several glands, sometimes during the course of many years between the start of each disease. The adrenal glands sit on top of the kidneys. The adrenal cortex, which is the outer region, secretes steroid hormones, which affect metabolism and suppress inflammation in the body. Aldosterone, which regulates the amount of salt excreted by the kidneys, is included in these hormones, and also small amounts of male hormones called androgens are found here. The amount of steroid hormones secreted by the adrenal cortex is regulated by a feedback loop with the hypothalamus and the pituitary gland. The hypothalamus sends a chemical signal, and the pituitary sends out ACTH, which directly stimulates the adrenal cortex. If levels of hydrocortisone in the body get too high, ACTH production is inhibited and slows the secretion of hydrocortisone. Emotional stress or injury can stimulate the release of ACTH and hydrocortisone. Addison’s disease itself is caused by inadequate secretion of both glucocorticoids and mineralocorticoids produced by the adrenal glands. Mineralocorticoids regulate electrolyte concentrations in extracellular fluids, which primarily are Na+ and K+ concentrations. Glucocorticoids help us to prevent stressors in the body, and affect the energy metabolism of most body cells. Addison’s disease can also be caused by hemorrhage, infections, tumors, or the use of anticoagulants. It sometimes runs in family histories. Adrenal failure, which is caused by damage or disease of the adrenal gland, results in a deficiency of cortisol. Cortisol and aldosterone are secreted by the adrenal cortex, and epinephrine and norepinephrine are linked to the medulla, which is the inner region of the adrenal gland. In Addison’s disease, autoantibodies attack the steroid-producing cells of the adrenal cortex, causing inflammation and fibrosis that prevents further hormone secretion. This will eventually completely destroy the adrenal cortex. In an adrenal crisis, there is increased secretion of ACTH from the anterior pituitary, which increases secretion of glucocorticoids from the adrenal cortex....
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