Addison's Disease: Stroke Symptoms And Their Causes Explained

Addison's disease is a rare disorder characterised by the inadequate production of the steroid hormones cortisol and aldosterone by the adrenal glands. The symptoms of Addison's disease include fatigue, gastrointestinal abnormalities, and changes in skin colour. Behaviour and mood changes may also occur.

Addison's disease can cause acute adrenal failure, which can lead to a sudden loss of strength, severe pain in the lower back, abdomen or legs, vomiting and diarrhoea, low blood pressure, and loss of consciousness. These symptoms can be triggered by stress, such as during an accident, trauma, surgery or severe infection.

There is evidence that Addison's disease is associated with an increased risk of ischemic stroke. However, the detailed mechanisms of how Addison's disease can cause stroke symptoms are not yet fully understood.

Addison's disease and stroke symptoms

Addisons Disease and Stroke Symptoms

Addison's disease is a rare condition affecting the adrenal glands, which sit on top of the kidneys. The adrenal glands produce hormones, including cortisol and aldosterone, which are essential for a healthy life. When the adrenal glands do not produce enough of these hormones, it results in Addison's disease.

Symptoms of Addison's Disease

Addison's disease symptoms vary from person to person and can be vague and nonspecific, often leading to delays in diagnosis. The most common symptom is chronic fatigue, with other possible symptoms including:

• Loss of appetite, inability to digest food, and weight loss
• Low blood pressure (hypotension), which can cause dizziness or fainting
• Dark patches of skin, especially on sun-exposed areas, as well as unexposed areas like the gums
• Low blood sugar (hypoglycemia)
• Nausea, vomiting, and diarrhea
• Mood changes, such as irritability and depression
• Craving for salty foods
• Abnormal periods
• Body hair loss and lower sexual drive in people assigned female at birth

Addison's Disease and Stroke

While searching for a connection between Addison's disease and stroke, I found a case study of a 15-year-old girl who presented with acute mental status change and was ultimately diagnosed with primary adrenal insufficiency (AI) due to autoimmune polyglandular syndrome type II (APS2) and stroke. Central nervous system imaging revealed a cerebral infarction. The authors of the case study noted that the combination of APS2, stroke, and acute mental status change had not been previously reported.

Additionally, a study on the prevalence of relative adrenal insufficiency in acute ischaemic stroke patients found that 65.5% of the patients admitted with acute ischaemic stroke had relative adrenal insufficiency. However, it is important to note that this study did not establish a direct causal link between Addison's disease and stroke.

Treatment and Management of Addison's Disease

Addison's disease is treated by replacing the missing hormones, cortisol and aldosterone, with synthetic versions. Cortisol is replaced by the drug hydrocortisone, and aldosterone is replaced by fludrocortisone. Treatment for Addison's disease is usually successful, and people with the condition can lead full, normal lives by taking their medication regularly. It is important for individuals with Addison's disease to carry a medical alert card and wear a bracelet or necklace indicating their condition in case of emergencies.

Adrenal insufficiency

Primary Adrenal Insufficiency

Primary adrenal insufficiency, or Addison's disease, occurs when the adrenal gland stops functioning correctly, making it unable to produce enough aldosterone and cortisol. This form of the condition happens in around 75% of cases and is usually caused by the body's immune system mistakenly attacking and damaging the adrenal cortex.

Secondary Adrenal Insufficiency

Secondary adrenal insufficiency occurs when the pituitary gland stops making adrenocorticotropin (ACTH), a hormone that helps the adrenal cortex function correctly. In these cases, the adrenal gland can still produce aldosterone but is unable to produce cortisol. Secondary adrenal insufficiency is often caused by traumatic brain injury or panhypopituitarism, a condition where the pituitary gland stops making most or all of the hormones it should.

Tertiary Adrenal Insufficiency

Tertiary adrenal insufficiency happens when the hypothalamus, a small area of the brain above the pituitary gland, stops making enough corticotropin-releasing hormone (CRH). CRH tells the pituitary gland to make ACTH, so without enough CRH, the adrenal glands cannot make enough cortisol. This form of the condition often occurs when someone suddenly stops taking steroid medications.

Symptoms of Adrenal Insufficiency

The symptoms of adrenal insufficiency include chronic fatigue, muscle weakness, loss of appetite, weight loss, low blood pressure, darkened skin, low blood sugar, nausea, vomiting, diarrhoea, mood changes, and intolerance to heat or cold.

Diagnosis of Adrenal Insufficiency

Treatment of Adrenal Insufficiency

Autoimmune polyglandular syndrome type II

The diagnosis of PAS-2 is often delayed, and this can sometimes cause significant complications. Usually, these patients present with isolated endocrine dysfunction and later develop other endocrine and non-endocrine diseases. The most common initial symptom of PAS-2 is the development of patches of skin that are darker than the surrounding skin (hyperpigmentation). This occurs most commonly near scars, by skin creases such as the knuckles, and on the mucous membranes such as the gums.

The treatment of PAS-2 is directed toward the specific symptoms that are apparent in each individual. Treatment may require the coordinated efforts of a team of specialists. Individuals with PAS-2 are treated by replacing the deficient steroid hormones (cortisol and aldosterone). Cortisol is replaced by the drug hydrocortisone, and aldosterone is replaced by the drug fludrocortisone.

Acute adrenal failure

Addison's disease is a rare disorder that affects the adrenal glands, causing them to produce inadequate amounts of the steroid hormones cortisol and aldosterone. This condition is also known as primary adrenal insufficiency. Cortisol, often referred to as the "stress hormone," is crucial for life, as it helps the body respond to stress, maintain blood pressure, regulate cardiovascular function, control blood sugar levels, and support the immune system. On the other hand, aldosterone regulates the balance of sodium and potassium in the blood, influencing blood volume and blood pressure.

In most cases, Addison's disease is caused by the body's immune system mistakenly attacking the adrenal glands, leading to progressive damage to the adrenal cortex. This autoimmune response accounts for approximately 75% of cases. Other causes include tuberculosis, repeated infections, cancer invading the adrenal glands, bleeding into the adrenal glands, and amyloidosis.

The symptoms of Addison's disease usually develop gradually and can vary among individuals. Fatigue is the most common symptom, followed by the appearance of patches of dark skin, known as hyperpigmentation. Other symptoms include nausea, vomiting, loss of appetite, unintentional weight loss, muscle pain, low blood pressure, mood and behavioural changes, cravings for salty foods, and low blood sugar.

In some cases, the symptoms of Addison's disease may appear suddenly, leading to a condition called acute adrenal failure or an Addisonian crisis. This is a medical emergency that can result in life-threatening complications such as shock or kidney failure if left untreated. An Addisonian crisis is typically triggered by stressful events such as accidents, trauma, surgery, or severe infections. During an Addisonian crisis, individuals may experience a sudden loss of strength, severe pain in the lower back, abdomen, or legs, vomiting, diarrhea, dehydration, low blood pressure, and loss of consciousness.

The treatment for Addison's disease involves replacing the deficient hormones, cortisol and aldosterone, with synthetic versions. Cortisol is replaced with the drug hydrocortisone, while aldosterone is replaced with fludrocortisone. As Addison's disease is a chronic condition, medication must be taken for life, with dosages adjusted during stressful situations to prevent acute adrenal crisis.

Addisonian crisis

Symptoms of an Addisonian Crisis

The onset of an Addisonian crisis is characterised by nonspecific symptoms such as fatigue, weakness, nausea, vomiting, abdominal pain, back pain, diarrhoea, dizziness, and hypotension. As the crisis progresses, individuals may experience obtundation, metabolic encephalopathy, and shock. It is important to note that these symptoms can also be indicative of other medical conditions, making the diagnosis of an Addisonian crisis challenging.

Risk Factors and Causes

Risk factors for an Addisonian crisis include physical stress, such as infection, dehydration, trauma, or surgery. It can also occur due to injury to the adrenal or pituitary glands or the premature discontinuation of steroid treatments.

The crisis itself is caused by a lack of cortisol, a hormone produced and released by the adrenal glands, which sit on top of the kidneys. Cortisol plays a crucial role in maintaining glucose regulation, suppressing the immune response, and responding to stress.

Treatment

The treatment for an Addisonian crisis involves addressing the underlying cause and providing supportive care. Intravenous fluids and parenteral glucocorticoid administration are essential to resolving the crisis. Additionally, individuals may require antibiotic therapy if the crisis is infection-related.

Prevention

To prevent an Addisonian crisis, individuals with adrenal insufficiency should have close routine follow-up care and be educated on adjusting their steroid doses during acute illness or stressful events. It is also crucial to carry identification, such as a medical bracelet or card, detailing their condition and medication requirements.

Frequently asked questions