Question

Beth is a 42-year-old Native American woman who presents to the clinic today with several concerns. She has been feeling lightheaded, tired, weak, nauseous, and has had no appetite for the past 6 months. She has lost weight, probably about 25 pounds she estimates. She believes her skin and lips are getting darker even though she has not been in the sun recently. She always feels dehydrated. After prompting, she admits that her hair under her arms and in the pubic area is much more sparse. Her menstrual cycles are regular. She does not report constipation or diarrhea. Upon further evaluation, her blood pressure is found to be 75/38 (low). Her blood glucose level is 61 mg/dL (low). Serum tests show hyponatremia and hyperkalemia. Serum cortisol levels are low even after stimulation of cortisol release through ACTH administration. She is told that she has Addison disease.

1. What is the most likely cause for Addison disease?

2. What hormones are absent or reduced because of the loss of the adrenal cortex?

3. What happens to ACTH levels with Addison disease?

4. Why is there skin hyperpigmentation with Addison disease?

5. What treatment strategies including dietary measures can she anticipate?

Answer 1

1) There are some major factor which can be referred as the most likely cause for Addison disease. The causes can be Usually
classified into primary and secondary cause. In primary the problem is in the adrenal gland especially within the
adrenal cortex, it produces lower level of hormones compared to normal individual. The hormones include
glucocorticoids, mineralocorticoids and the androgen.

In secondary the problem is in brain, specifically in the pituitary gland, due to this there will be an inadequacy in the
secretion of ACTH , which affects the adrenal to produce the respective hormones causes Diseases. All this happen
because of self destruction in the body.

2) The hormones that are absent or reduced because of the loss of the adrenal cortex are;

• Androgens
• Corticoids ( mineralocorticoids and glucocorticoids)

3). ACTH level in this condition will be reduced drastically due to problem in the
pituitary gland in the brain, so further it leads to hormonal imbalance in the body.

4). The hyperpigmentation seen on this condition is majorly due to the hormonal imbalance, related to ACTH
due to this there will be an increased melanin can be seen on the body, which causes this symptoms.

5). The diet pattern play major intervention among this type of clients. The diet include

• foods which are rich in Carbs and proteins.
• There will be additional provision of calcium and Vit.D to protect the
  client from bone problems.
• Avoid activities which may cause anxiety and free from stress full
  environment.