Addison Disease (cont.)
Tuberculosis
Tuberculosis (TB), an infection which can destroy the adrenal glands, accounts for about 20 percent of cases of primary adrenal insufficiency in developed countries. When adrenal insufficiency was first identified by Dr. Thomas Addison in 1849, TB was found at autopsy in 70 to 90 percent of cases. As the treatment for TB improved, however, the incidence of adrenal insufficiency due to TB of the adrenal glands has greatly decreased.
Other causes
Less common causes of primary adrenal insufficiency are:
- chronic infection, mainly fungal infections
- cancer cells spreading from other parts of the body to the adrenal
glands
- amyloidosis
- surgical removal of the adrenal glands
Secondary adrenal insufficiency
This form of adrenal insufficiency is much more common than primary adrenal
insufficiency and can be traced to a lack of ACTH. Without ACTH to stimulate the
adrenals, the adrenal glands' production of cortisol drops, but not aldosterone.
A temporary form of secondary adrenal insufficiency may occur when a person who
has been receiving a glucocorticoid hormone such as prednisone for a long time
abruptly stops or interrupts taking the medication. Glucocorticoid hormones,
which are often used to treat inflammatory illnesses like rheumatoid arthritis,
asthma, or ulcerative colitis, block the release of both corticotropin-releasing
hormone (CRH) and ACTH. Normally, CRH instructs the pituitary gland to release
ACTH. If CRH levels drop, the pituitary is not stimulated to release ACTH, and
the adrenals then fail to secrete sufficient levels of cortisol.
Another cause of secondary adrenal insufficiency is the surgical removal of
benign, or noncancerous, ACTH-producing tumors of the pituitary gland (Cushing's
disease). In this case, the source of ACTH is suddenly removed, and replacement
hormone must be taken until normal ACTH and cortisol production resumes.
Less commonly, adrenal insufficiency occurs when the pituitary gland either
decreases in size or stops producing ACTH. These events can result from:
- tumors or infections of the area
- loss of blood flow to the pituitary
- radiation for the treatment of pituitary tumors
- surgical removal of parts of the hypothalamus
- surgical removal of the pituitary gland
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Addison's Disease - Treatments
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