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Adrenal  Failure

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Causes of adrenal failure Thomas Addison first identified the disease in 1855 while working at Guy's Hospital in London. At that time, the main cause of the disease was as a complication of tuberculosis. TB still remains an important cause of Addison's in Third World countries. HIV (AIDS) is now becoming another significant infectious disease causing adrenal failure among third world population.

In more affluent countries, the most frequent cause of Addison's disease is destructive atrophy whereby an over-active immune system starts attacking the body's own organs; in this case, the adrenals. This accounts for around 70% of all cases and affects more women than men. In common with most other autoimmune diseases, the exact reason for the atrophy is unknown.

Other, much rarer causes of Addison's include certain fungal infections, adrenal cancer and adrenal haemorrhage (for example, following a car accident).Addison's disease is not usually apparent until over 90% of the adrenal cortex has been destroyed, so that very little adrenal capacity is left. This can take months to years and is known as primary adrenal insufficiency. Symptoms of the disease, once advanced, can include severe fatigue and weakness, loss of weight, increased pigmentation of the skin, faintness and low blood pressure, nausea, vomiting, salt cravings and painful muscles and joints. Because of the rather non-specific nature of these symptoms and their slow progression, they are often missed or ignored until, for example, a relatively minor infection leads to an abnormally long convalescence which prompts an investigation. Frequently, it is not until a crisis is precipitated that attention is turned to the adrenals.

Secondary failure

Secondary adrenal insufficiency is sometimes described as "Addison's", although it has a very different cause. It mostly occurs when a pituitary tumour (such as an adenoma) forms, although autoimmune destruction of the pituitary gland is also known. In secondary adrenal insufficiency, the pituitary gland no longer triggers the adrenals to produce cortisol, and DHEA production is also believed to decline.  In most cases of secondary adrenal insufficiency, however, aldosterone is still produced, as its production is stimulated by other hormonal regulatory systems.  The pituitary hormone which triggers cortisol production is called ACTH; it is responsible for the extra pigmentation found in primary Addison's.  People with secondary adrenal failure do not experience the extra pigmentation found in primary Addison's, because their ACTH levels are declining.

Long term use of high doses of steroid drugs to treat other illnesses (for example high-dose prednisone for bowel disease or asthma) can also cause temporary or permanent loss of adrenal function.  This is often referred to as secondary adrenal suppression.

Until the development of steroid medication in the late 1940s, the outcome of adrenal disease was invariably fatal.  With the development of modern steroid medications, individuals with Addison's disease can expect to have a fairly normal life span, provided they manage their daily medication sensibly.  People with Addison's must always be aware of their own health and ready to increase their dosage if they get sick or are seriously injured.

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