endocrine and metabolic disorders
Addison Disease
Introduction
Addison disease is an insidious, usually progressive hypofunctioning of the adrenal cortex. It causes various symptoms, including hypotension and hyperpigmentation, and can lead to adrenal crisis with cardiovascular collapse. Diagnosis is clinical and by finding elevated plasma adrenocorticotropic hormone (ACTH) with low plasma cortisol. Treatment depends on the cause but generally includeshydrocortisoneand sometimes other hormones. (See also Overview of Adrenal Function .) Addison disease develops in about 4/100,000 annually. It occurs in all age groups, about equally in each sex, and tends to become clinically apparent during metabolic stress, infection, or trauma. Adrenal crisis(onset of severe symptoms) may be precipitated by acute infection. Infection is a common cause, especially when there is septicemia. Other causes include trauma, surgery, and sodium loss due to excessive sweating. Even with treatment, Addison disease may cause a slight increase in mortality. It is not clear whether this increase is due to mistreated adrenal crises or long-term complications of inadvertent over-replacement. 