What is the Cause of Addison's Disease?

Have you ever felt unusually tired or noticed darkening of your skin without sun exposure? These could signal Addison’s disease, which is a rare but serious condition. It occurs when the immune system attacks the adrenal glands, reducing hormone production like cortisol and aldosterone. Early diagnosis and treatment can help manage symptoms and prevent complications.

Causes of Addison's Disease

Only 1 in 100,000 people is affected by Addison's disease. Besides autoimmunity, the most common cause, several other factors contribute to adrenal insufficiency:

1. Withdrawal of Corticosteroids: Corticosteroids are often prescribed to manage inflammation caused by autoimmune conditions such as lupus, inflammatory bowel disease, and rheumatoid arthritis. Prolonged usage of corticosteroids can suppress the adrenal glands, leading to secondary adrenal insufficiency. A sudden withdrawal after long-term use may result in hormonal imbalance.
   
   According to a review published in PubMed, approximately 1% - 3% of the general population uses corticosteroids regularly, placing them at potential risk.
2. Infections: Certain infections can damage the adrenal cortex. Historically, tuberculosis (TB) was the leading cause of Addison’s disease, as first observed by Sir Thomas Addison. Today, while TB still plays a role in some countries, fungal infections, cryptococcus neoformans, and HIV/AIDS are also recognised causes.
   
   Some of the studies published indicate that 39% to 51% of Addison’s disease cases worldwide are linked to infectious causes.
3. Stress: Chronic or excessive stress does not directly cause Addison’s disease, but it can worsen the symptoms or trigger an adrenal crisis in patients already affected. The adrenal glands are unable to meet the demand for cortisol during stress, causing fatigue and hypotension.

What is the Best Treatment for Addison's Disease?

Treatment of this disease focuses on replacing the deficient hormones. The two primary medications include:

• Hydrocortisone – replaces cortisol.
• Fludrocortisone acetate –replaces aldosterone.
   

These medications help manage symptoms and prevent adrenal crises. Regular monitoring and dosage adjustments are necessary during illness or stress.

What Foods Should You Avoid with Addison's Disease?

People with Addison’s disease are often advised to consume a high-sodium diet, particularly during hot weather or physical exertion.

However, excessive potassium intake can worsen symptoms due to reduced aldosterone. As per NHS guidelines, foods to limit include:

• Bananas
• Lentils
• Squash
• Raisins
• Kidney beans
• Orange juice
• Soybeans
   

A well-balanced diet rich in calcium and vitamin D (such as dairy, eggs, and fortified cereals) is beneficial for bone health, especially in those on long-term steroid therapy.

Due to aldosterone deficiency, some individuals with Addison's disease may need to be mindful of very high potassium intake. However, for most patients on proper fludrocortisone replacement, a normal, balanced diet is sufficient. It is important to have regular blood tests to monitor sodium and potassium levels, and any specific dietary restrictions should be discussed with a doctor or dietitian.

What are the complications of Addison's disease?

Without proper treatment, Addison's disease can lead to an adrenal crisis, which is a medical emergency. Some complications that it can lead to are:

• Severe abdominal, leg, or lower back pain
• Vomiting and dehydration
• Low blood pressure
• Delirium and hallucinations
• Loss of consciousness
   

An adrenal crisis is a life-threatening medical emergency caused by a severe deficiency of cortisol. It can be triggered by physical stress, infection, injury, or missing medication doses in a person with adrenal insufficiency.