Addison's+Disease

Western Diagnosis adrenocortical insufficiency "neurasthenia" correlates to hypoadrenalism

Etiology
1. idiopathic atrophy of adrenal gland probably due to autoimmune factors in 70% 2. TB, neoplasm, infl necrosis

Pathophysiology
1. adrenal produces glucocorticoids (cortisol), mineralocorticoids (aldosterone), androgens (DHEA - dehydroepiandrosterone) 2. inc excretion of sodium, dec excretion of potassium - low serum Na, high serum K 3. cortisol def ---hypotension ---disturbances in CHO, pro, fat metabolism: severe insulin sensitivity ---insufficient CHO formed from protein: hypoglycemia, dec liver glycogen 4. DHEA def ---hypothesized: allergies, aging, CA

Signs & Symptoms
1. weakness, fatigue 2. orthostatic hypotension 3. inc skin pigmentation - esp over bony prominences, skin folds, scars, extensor surfaces 4. black freckles over forehead, face, neck, and shoulders 5. vitiligo 6. bluish-black discoloration of areolae and mucous membranes 7. weight loss, dehydration, hypotension 8. cold intolerance 9. dizziness, syncope 10. anorexia, Nausea, Vomiting, Diarrhea

---precipitated by acute infection, trauma, surgery, Na loss due to xs sweating in hot weather ---profound asthenia ---severe abdominal, low back, or leg pain ---peripheral vascular collapse ---renal failure - azotemia (nitrogen in the blood stream) ---life-threatening emergency
 * adrenal crisis**

Laboratory
1. low serum Na, high serum K - Na:K <30:1 2. low serum cortisol or urinary free cortisol with an elevated serum ACTH 3. failure to increase either serum cortisol or urinary free cortisol after administration of ACTH - doubles in 30-90 minutes 4. salivary cortisol and DHEA

Diagnosis
1. clinical 2. lab tests 3. pts with adrenal function but limited reserves may appear normal until stress precipitates an attack or sx

Treatment
1. replacement - hydrocortisone, aldosterone 2. in subclinical: ---vit. C ["always"] ---pantothenic acid ["always"] ---adrenal precursor herbs ---adrenal extract ---DHEA ?

3 most important things for low adrenal function diet: eating every 2 hours. plenty of protein and some complex carbs exercise: do not exercise to tiredness relaxation: meditation should expect it to take a while - minimum of a year

research licorice: important in adrenal function d/t pseudoaldosterone and blocks degredation of cortisol ashwaghanda: 500mg TID lowered cortisol levels by 30% Ginsengs (all): have an adrenal gland effect Ginger: also helpful

Acupuncture points that did not elicit a cortisol response: ST-36, Yintang