MYTH: Disorders of the adrenal glands cause both primary and secondary adrenal insufficiency.
FACT: Disorders of the adrenal glands cause primary adrenal insufficiency.
MYTH: Most cases of Addison's disease are caused by infection or trauma.
FACT: About 70% of Addison's disease cases are caused by autoimmune disorders. In primary Addison's disease, this leads to gradual destruction of the adrenal cortex. Secondary Addison's disease is caused by inadequate secretion of adrenocorticotropic hormone (ACTH) from the pituitary gland.
MYTH: For most patients, symptom onset is sudden.
FACT: Clinical manifestations of Addison's disease develop gradually. Common signs and symptoms include chronic, escalating fatigue; muscle weakness; loss of appetite; and weight loss. Patients may also experience abdominal pain, nausea, vomiting, diarrhea, decreased resistance to infection or stress, low blood pressure with orthostatic changes, amenorrhea or irregular menstrual periods, decreased libido, decreased pubic and axillary hair, irritability, depression, hyperpigmentation, a craving for salty foods, hyponatremia, and hyperkalemia.
MYTH: X-ray studies are the most specific test to diagnose Addison's disease.
FACT: Stimulation with ACTH is the most specific diagnostic test for Addison's disease, although imaging studies and X-rays of the adrenal and pituitary glands can help determine a primary or secondary cause. In the rapid ACTH test, the patient receives an IN. injection of a synthetic form of ACTH. His blood cortisol level is measured before the injection and 30 to 60 minutes after the injection. Normally, urine and blood cortisol levels increase; patients with any form of adrenal insufficiency won't respond or barely respond.
MYTH: A patient with Addison's disease relies on parenteral medication to maintain stability.
FACT: The patient will take oral hydrocortisone for maintenance therapy. He may need to raise the dosage in certain conditions, such as mild respiratory infection or emotional stress.
EDWINA A. McCONNELL, RN, PHD, FRCNA
Edwina A McConnell is an independent nurse-consultant in Gorham, Me. Selected references for this article are available on request.
Copyright Springhouse Corporation Aug 2002
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