The gradual destruction of the adrenal cortex, the outer layer of the adrenal glands, by the body’s immune system causes up to 80 percent of Addison’s disease cases.2 In autoimmune disorders, the immune system makes antibodies that attack the body’s own tissues or organs and slowly destroy them.
Adrenal insufficiency occurs when at least 90 percent of the adrenal cortex has been destroyed. As a result, often both cortisol and aldosterone are lacking. Sometimes only the adrenal glands are affected. Sometimes other endocrine glands are affected as well, as in polyendocrine deficiency syndrome.
Polyendocrine deficiency syndrome is classified into two separate forms, type 1 and type 2.
Type 1 is inherited and occurs in children. In addition to adrenal insufficiency, these children may have
• underactive parathyroid glands, which produce a hormone that regulates calcium and phosphorus balance in the body
• slow sexual development
• pernicious anemia, a severe type of anemia
• chronic candida infections, a type of fungal infection
• chronic active hepatitis, a liver disease
Type 2, sometimes called Schmidt’s syndrome, usually affects young adults and may include
• an underactive thyroid gland, which produces hormones that regulate metabolism
• slow sexual development
• vitiligo, a loss of pigment on areas of the skin
Scientists think type 2 polyendocrine deficiency syndrome is also inherited because often more than one family member has one or more endocrine deficiencies.
Tuberculosis (TB), an infection that can destroy the adrenal glands, accounts for less than 20 percent of cases of Addison’s disease in developed countries. When adrenal insufficiency was first identified by Dr. Thomas Addison in 1849, TB was the most common cause of the disease. As TB treatment improved, the incidence of adrenal insufficiency due to TB of the adrenal glands greatly decreased.
Less common causes of Addison’s disease are
• chronic infection, mainly fungal infections
• cancer cells spreading from other parts of the body to the adrenal glands
• amyloidosis, a disease that causes abnormal protein buildup in, and damage to, various organs
• surgical removal of the adrenal glands
• AIDS-associated infections
• bleeding into the adrenal glands
• genetic defects including abnormal adrenal gland development, an inability of the adrenal gland to respond to ACTH, or a defect in adrenal hormone production
Secondary adrenal insufficiency can be traced to a lack of ACTH. Without ACTH to stimulate the adrenal glands, the adrenals’ production of cortisol drops. Aldosterone production is not usually affected.
A temporary form of secondary adrenal insufficiency may occur when a person who has been taking a synthetic glucocorticoid hormone such as prednisone for a long time stops taking the medication, either ...
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