Addison's disease predominantly affects adults between 30 and 50 years, and especially women. The causes of disease must be identified in all the morbid conditions that lead to the almost complete destruction (over 90%) of the adrenal cortex.

About 70% of cases of Addison's disease are caused by autoimmune aggression of the gland (adrenal atrophy, autoimmune or idiopathic atrophy of the adrenal cortex).

The form of autoimmune Addison's can occur in 3 forms:

Pluriendocrina · involve a type I syndrome (hypoparathyroidism, adrenal insufficiency, primary hypogonadism, mucocutaneous candidiasis, pernicious anemia)

· Involve a pluriendocrina syndrome type II, also called Schmidt syndrome (adrenal insufficiency, autoimmune thyroid disease, diabetes mellitus insulin-dependent)

· Form isolated

Therefore it is important to the detection of auto-antibodies directed to other types of glandular structures.

In 20-25% of cases of Addison's disease is a consequence of the destruction of the gland by granuloma especially tuberculosis (which has recently become more frequent in developing countries), and in rare cases, the Addison is due to destructive lesions of gland by primary or metastatic adrenal tumors (lymphomas), adrenal hemorrhage or infarction, amyloidosis, fungal infections and CMV infections (mainly AIDS). Among the minor causes also remember congenital adrenal hypoplasia, Addison's disease to iatrogenic and that by bilateral adrenalectomy.

Symptoms of Addison’s disease

The symptoms of Addison's disease acknowledge fatigue, physical and mental fatigue, sometimes cramps and muscle pain, impaired concentration, emotional instability and depressed mood, weight loss, loss of appetite, nausea and vomiting, orthostatic hypotension, sometimes signs hypoglycaemia. Blood pressure is low enough to cause episodes of circulatory collapse. Characteristic of the primitive form is the effect of intense tan hyperpigmentation, especially the palms of the hands and feet, and skin folds (which is why once the disease took its name badly bronzed). The woman may also occur depletion of hair and amenorrhoea, while in humans occur sometimes impotence and loss of libido.

CAUSE

Primitive forms are distinguished, called Addison's disease in the strict sense, where the alteration affects the adrenal gland directly, and secondary forms, caused by impaired pituitary hormone ACTH, or adrenocorticotropina for pituitary or hypothalamic damage. In the latter case, some scholars speak of white Addison's disease, because the skin color does not change, whereas in primitive forms the skin is usually dark, to increase the deposition of melanin. The disease is chronic and develops slowly, usually in middle-aged, mostly female. The most common causes are primitive forms of tuberculosis of the adrenal gland or autoimmune diseases, those of secondary forms, cranial radiotherapy, surgery sull'ipofisi, brain tumor.

Recommended Therapy

The therapy is chronic and consists of corticosteroids and dietary supplementation with NaCl. The main problem with this type of treatment is the danger of an acute crisis hypoadrenalism in case of suspension of therapy, as may happen in case of febrile episodes, gastroenteritis, trauma etc. In all these situations, therapy dell'iposurrenalismo not only is not completely suspended, but must be adequately strengthened, under strict medical supervision.