Review Article
Volume 15 Issue 7 - 2019
Addison’s Disease Diagnosis and Management
Sami Ahmed Bilal1*, Mohmed Salem Basalama2, Saad Thamer A Alshahrani3, Ageel Bati Alharbi4, Sufyan Ahmad Alkhalaf5, Fahad Saleem Alhawati5, Ahmad Hamza Omar Khalid6, Sultan Sameer Alhunbusi7, Khalid Saleh Bamahfuth8, Aqeela Ali Hasan Mohamed Sharif Alaradi9, Haram Hafiz Osman Elhassan10 and Ahmed Hamza Alnashri11
1Consultant of Internal Medicine, King Fahad General Hospital, Jeddah, Saudi Arabia
2King Fahad General Hospital, Jeddah, Saudi Arabia
3King Khalid University, Abha, Saudi Arabia
4Dammam Medical Complex-Eastern Province, Saudi Arabia
5King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
6King Faisal Medical Complex, Taif, Saudi Arabia
7King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia
8King Abdulaziz University, Jeddah, Saudi Arabia
9Zhejiang University, China
10Bahri University, Sudan
11Umm Al-Qura University, Mecca, Saudi Arabia
*Corresponding Author: Sami Ahmed Bilal, Consultant of Internal Medicine, King Fahad General Hospital, Jeddah, Saudi Arabia.
Received: June 14, 2019; Published:June 21, 2019




Abstract

Introduction: Recent research in the field of immunopathology has significantly enhanced our understanding of the concepts of autoimmune diseases, specifically of Addison’s disease. Addison’s disease is considered to be a chronic medical condition that is characterized by the presence of adrenocortical gland insufficiency that occurs after a chronic and often asymptomatic period, characterized by circulating autoantibodies which are directed to adrenal cortex antigens. In this review we will describe the categories of subjects who are at risk of having Addison’s disease, as well as he diagnostic tests that are known to be the best for assessing the adrenal functions: the determination of basal plasma adrenocorticotropic hormone (ACTH) concentrations, the activity of plasma renin, plasma aldosterone and cortisol concentrations, and cortisol concentrations following IV stimulation with ACTH (known as ACTH test). The use of specific clinical, immunological and functional criteria in patients with autoantibodies to against the adrenal cortex makes it possible to identify those subjects who are at risk of having an overt disease. The independent risk factors for the development of adrenal failure contribute to different predisposing factors of developing clinical Addison’s disease.

Based on the level of risk, patients must be strictly monitored over time to detect the presence of early signs of any adrenal dysfunction and start substitutive management as early as possible. For subjects who present with high risk, prophylactic strategies and trials may be beneficial.

Aim of Work: In this review, we will discuss Addison’s disease.

Methodology: We did a systematic search for Addison’s disease diagnosis and management using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). All relevant studies were retrieved and discussed. We only included full articles.

Conclusions: Primary adrenal insufficiency, also known as Addison disease, has many etiologies, the most common of which is a condition called autoimmune adre­nalitis. Autoimmune adrenalitis is a result of the destruction of the adrenal cortex gland, which causes deficiencies in glucocor­ticoids, mineralocorticoids, and adrenal androgens. In the US and Western Europe, the estimated prevalence of Addison disease is about in 20,000 persons; thus, a high clinical suspicion is required to prevent misdiagnosing a life-threatening adrenal crisis (like shock, hypotension, and volume depletion). Signs and symptoms prior to an adrenal crisis are subtle and could include hyperpigmentation, fatigue, anorexia, orthostasis, nausea, muscle and joint pain, and salt craving. Cortisol concentrations reduce and adrenocorticotropic hormone concentrations elevate. When clinically suspected, patients must undergo a cosyntropin stimulation test to confirm the presence of the disease. Management of primary adrenal insufficiency needs replacement of mineralocorticoids and glucocorticoids. During times of stress (like illness, inva­sive surgical procedures), stress-dose glucocorticoids are needed as the destruction of the adrenal glands prevents a sufficient physiologic response. Management of primary adrenal insufficiency or autoimmune adrenalitis needs vigilance for concomitant autoimmune diseases; up to half the patients will develop another autoimmune disorder during their lifetime.

Keywords: Addison’s Disease; Presentation; Diagnosis; Management

References

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Citation: Sami Ahmed Bilal., et al. “Addison’s Disease Diagnosis and Management”. EC Microbiology 15.7 (2019): 623-629.

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