Endocrine & Hormonal
Also called Primary Adrenal Insufficiency, Hypoadrenalism
Addison Disease results from destruction of 90% or more of the adrenal cortex, most commonly due to autoimmune adrenalitis (caused by autoantibodies against 21-hydroxylase enzyme). Less common causes include tuberculosis, fungal infections, metastatic cancer, adrenoleukodystrophy, and genetic disorders.
Addison Disease most commonly presents in the third to fifth decades of life but can occur at any age. It affects males and females roughly equally. The disease occurs across all racial and ethnic groups, though some reports suggest higher prevalence in Northern Europe and lower prevalence in African and Asian populations. Autoimmune Addison is associated with other autoimmune conditions in 40-60% of patients (polyglandular autoimmune syndrome). Patients with genetic syndromes (APS1, AIRE mutations) have very early onset.
Research in Addison Disease focuses on understanding autoimmune mechanisms, improving androgen replacement (particularly DHEA), and optimizing glucocorticoid and mineralocorticoid replacement therapy. Trials investigating immunomodulatory approaches to prevent disease progression are emerging. Management emphasizes glucocorticoid and mineralocorticoid replacement tailored to individual needs, with education about stress dosing during illness or surgery. Patients should consult with an endocrinologist familiar with adrenal insufficiency for optimal management.
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