Addison

Addison's disease: after 40 years much remains the same British Medical Journal, Feb 24, 2001 by Sarah Baker, Deana Kenward, Katherine G White EDITOR--Hilditch was diagnosed as having Addison's disease 40 years ago, when blood tests were more expensive and less frequently used for general screening than they are now.[1] Her experience that the disease was not diagnosed until she was near death is, however, still common to many patients today and prompts the remark that "Getting diagnosed is the hardest part of this disease." Early detection of Addison's disease is not easy: non-specific symptoms and fatigue may be overlaid by signs of depression (as is also the case with hypothyroidism). Some patients never develop the full classical triad of hyperpigmentation, hypotension, and hyponatraemia. The nature of the disease also means that patients who have struggled with subclinical symptoms for years as their adrenal function deteriorates suddenly become vulnerable to a crisis when they meet flu or another illness which they no longer have the adrenal reserves to combat. Some patients report having been admitted to hospital with a crisis more than once before their disease is diagnosed. In some cases, the reluctance of medical practitioners to consider an uncommon cause of disease remains a factor in late diagnosis. It is only four years since a Lesson of the Week in the BMJ documented the deaths of two young patients whose Addison's disease was not diagnosed until necropsy.[2] The first of these deaths took place in hospital; simple screening tests had raised Addison's disease as a possibility but were not acted on. Addison's disease is relatively cheap and simple to treat. Our hope is that, by raising awareness of the condition, patients like Hilditch do not have to live with poor and deteriorating health until such time as an Addisonian crisis requiring admission to hospital prompts diagnosis. Stem Cell Projects Pave The Way For New Therapies The Medical Research Council has announced funding for seven awards totalling £4.7 million under its translational stem cell research scheme. This includes nearly £3 million for four early stage clinical trials involving adult stem cells. These trials will assess various aspects of stem cell biology - using stem cell transplantation to address blindness and bone repair, to activate dormant stem cells within the body to treat Addison's disease and to target the elimination of cancerous stem cells responsible for chronic myeloid leukaemia. The MRC Translational Stem Cell Funding Scheme was launched last year to specifically support the application of stem cell research, with the primary aim of driving promising stem cell science towards clinical application. This mechanism has been designed to support research on a broad range of stem cell types, building on the excellence of stem cell research in the UK. Translational Stem Cell Research Committee (TSCRC) chairman Professor Ian Greer said: The projects funded are primarily focused on transplanting or stimulating the patient's own stem cells, which reflects what is currently achievable in clinical settings using stem cell technology. Progress is also being made towards the therapeutic use of embryonic stem cells, although the complexity of manipulating such cells in the laboratory prior to transplantation means that the first clinical trials may still be several years away.

Adrenal Insufficiency and Pregnancy

The evidence on adrenal insufficiency and pregnancy shows that most women with the condition who become pregnant are able to have an uncomplicated pregnancy. Women with adrenal insufficiency who become pregnant receive the standard adrenal insufficiency treatment; if nausea and vomiting in early pregnancy interfere with oral medication, injections of the hormone may be necessary. As long as the proper precautions are taken -- and intake of treatment medication is closely monitored -- the prognosis for women with adrenal insufficiency during pregnancy is generally good. Most women with adrenal insufficiency who become pregnant are able to have an uncomplicated pregnancy, labor, and delivery. As in women who are not pregnant, close monitoring and taking the correct medications is important. Women with adrenal insufficiency who become pregnant receive the standard adrenal insufficiency treatment. If nausea and vomiting in early pregnancy interfere with oral medication, injections of the hormone may be necessary. During delivery, women are treated with injections of hydrocortisone and saline. Following delivery, the dose of adrenal insufficiency medications is gradually tapered and the usual maintenance doses of hydrocortisone and fludrocortisone acetate by mouth are reached by about 10 days after childbirth.

Last updated/reviewed: June 22, 2006 Written by/reviewed by: Arthur Schoenstadt, MD Adrenal Insufficiency and Colonic Inflammation after a Novel Chronic Psycho-Social Stress Paradigm in Mice: Implications and Mechanisms S. O. Reber, L. Birkeneder, A. H. Veenema, F. Obermeier, W. Falk, R. H. Straub and I. D. Neumann We investigated chronic psycho-social stress effects on stress-related parameters and on pathohistological changes in the murine colon. Moreover, we aimed to reveal the involvement of adrenal glucocorticoids in chronic stress effects. Chronic subordinate colony housing (CSC, 19 d) resulted in reduced body weight gain, thymus atrophy, adrenal hypertrophy, increased plasma norepinephrine, and increased anxiety. With respect to the time course of CSC effects, CRH mRNA in the hypothalamic paraventricular nucleus, light phase corticosterone and tyrosine hydroxylase expression in colonic tissue were found to be increased, whereas tyrosine hydroxylase expression in the locus coeruleus was found to be decreased on d 2 of CSC; these parameters returned to control levels thereafter. Nevertheless, after 19 d of CSC exposure, the adrenal corticosterone responses in vivo and in vitro, and glucocorticoid sensitivity of isolated splenic cells were found to be decreased. Importantly, in CSC mice a significant histological damage of the colon was found beginning on d 14 of CSC exposure. Additionally, pro- and antiinflammatory cytokine secretion by mesenteric lymph node cells was increased after CSC exposure. Adrenalectomy before CSC at least partially prevented these chronic stress effects as reflected by less increase in proinflammatory cytokine secretion and an equal histological damage score in adrenalectomized compared with sham-operated CSC mice. In conclusion, chronic exposure to CSC alters relevant neuronal, neuroendocrine and immune functions that could be directly or indirectly involved in the damage of the histological integrity of the colon comparable with that seen during the development of colitis. http://endo.endojournals.org/cgi/content/abstract/148/2/670

Fine tuning for quality of life: 21st century approach to treatment of Addison's disease. Despite treatment with glucocorticoids and mineralocorticoids, the ability to work and quality of life of patients who have adrenal insufficiency remains low. There are no helpful objective

measures of optimal glucocorticoid replacement, so this is best achieved by careful clinical assessment. Adequacy of mineralocorticoid replacement may be judged by assessing postural change in blood pressure, serum electrolytes, and plasma renin activity. Novel delayed-release and sustained-release formulations of hydrocortisone seem to more closely mimic diurnal serum cortisol rhythms than conventional hydrocortisone tablets. Such preparations are currently being evaluated and may play a role in management of patients who have adrenal insufficiency. Author/s: Reisch, Nicole (N); Arlt, Wiebke (W); Journal: Endocrinology and metabolism clinics of North America