Question

Addisons Disease is an autoimmune condition in which antibodies attack the adrenal glands, which slows or stops the hormones produced by these glands, thereby altering the normal homeostasis of the body. Discuss two hormones that would be affected by this disease. What effects would be seen as a result of this disease?

Answer 1

Ans) Addison disease can be primary or secondary depending upon site of lesion. Involvement of adrenals is primary adissons and involvement of pituitary gland or hypothalamus is secondary.

all three zones of adrenal Cortex are involved to some extent in adissons disease so there is -

1) Glucocorticoid insufficiency

2) Mineralocorticoid insufficiency

3)loss of adrenal androgens

4) increased secretion of ACTH.

* In Addison disease since the adrenal glands are involved ACTH or adrenocorticotrophic hormone levels are affected. High levels of ACTH produces pigmentation of sun exposed areas , asthenia ( loss of strength or weakness), postural hypotension as a sign. 10 to 20% cases present with vitiligo due to hypopigmentation.

* Loss of androgens or reduced production of estrogen and testosterone causing sparse axillary and public hair in females.

* Glucocorticoid insufficiency that is cortisol insufficiency causes weight loss, malaise, anorexia, Nausea and vomiting, weakness, diarrhea, fatigue etc.

(cortisol mainly regulates metabolism by regulating metabolism of sugar by glycolysis, controls blood sugar levels, under stressfull conditions cortisol elevates blood sugar levels inturn increasing the availability of glucose to organs and brain for energy and repair of tissues. Decreased cortisol levels slows down metabolism of sugars, and energy production causing symptoms of weight loss malaise weakness etc as mentioned above. )

* Mineralocorticoid insufficiency or aldosterone insufficiency causes hypotension or low BP.

( aldosterone maintains the blood pressure by managing the concentration of sodium ions and pottasium ions in the body and helps in water retention, without aldosterone kidney loses excess amounts of sodium ions through urination causing dehydration and also reduced blood pressure causing hypotension as mentioned above. )

The management of this disaese is replacement therapy that is Glucocorticoid replacement with prednisone. Mineralocorticoid replacement with fludrocortisone and androgen with adrenal androgen DHEA.

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