Modern Family Doctor

While cold and cough are common, diseases like Addison’s disease are rare. It is also known as chronic adrenal insufficiency or hypocortisolism as it is a result of insufficient production of hormones like cortisol and aldosterone by the adrenal glands. This disease can affect men and women of any age.

There are two types of Addison’s disease. These are:

1. Primary adrenal insufficiency: In this case, the adrenal glands themselves have a problem.
2. Secondary adrenal insufficiency: If the hormone production in the adrenal glands is restricted by a problem that has started somewhere else like the pituitary gland, for example, it is known as secondary adrenal insufficiency.

Primary adrenal insufficiency is more common of the two. This could be triggered as a result of autoimmune diseases or a long lasting infection such as HIV, tuberculosis and some fungal infections. Cancer can also cause this type of Addison’s disease.

Secondary adrenal insufficiency is usually caused by a problem with the pituitary gland or the hypothalamus as they are responsible for the production of hormones that stimulate the adrenal glands. Damage caused to the pituitary gland by tumors or radiation and surgery can also interfere with hormone production. Prolonged and improper use of steroid hormones can also trigger this condition.

Addison’s disease has a very slow progression and its symptoms develop gradually over time. Some of these symptoms are:

1. Weight loss and loss of appetite
2. Extreme fatigue
3. Hyperpigmentation
4. Low blood pressure
5. Craving for salt
6. Nausea and diarrhea
7. Pain in the abdomen and joint pains
8. Irritability
9. Depression
10. Loss of body hair and sexual dysfunction in women

Treatment for Addison’s disease involves hormone replacement therapy. This aims at correcting the hormone levels in the body. Hormone replacement therapy includes oral corticosteroids and corticosteroid injections. The dosage of these steroids could vary depending on the situation. For example, the doctor may suggest a temporary high dosage when the patient is in a stressful condition. Along with this, sodium is also recommended especially during the summer months and while exercising. This medication must be taken regularly as skipping a single dose can be dangerous.

In some cases this condition can become life threatening. An addisonian crisis causes a drop in blood pressure, sugar and a spike in potassium levels in the body. This requires immediate medical attention and can be treated with intravenous injections of hydrocortisone, saline solution and sugar. If you wish to discuss about any specific problem, you can consult an endocrinologist..

The body has multiple chemicals called hormones, which regulate many of its functions. Increased or decreased levels of these hormones affect various functions including metabolism, growth and sexual functions. Thyroxin produced by the thyroid (situated in the front of the neck) is one such hormone, which has a significant role to play in metabolism.

Graves’ disease is one of the main causes of hyperthyroidism, where there is excessive production of thyroid hormones. Graves’ disease is an autoimmune disorder, wherein the body reacts against its own tissues. It is very common in women than men, especially after 20 years of age. Family history also has a strong correlation in developing Graves’ disease. The high levels of thyroid hormone increase the rate of metabolism, thereby altering weight, mental energy levels, physical stamina, and also mood.

Thyroid hormone is related to metabolism and more amount of it lead to higher metabolism. This causes the following symptoms.

1. Intolerance to heat
2. Excessive sweating
3. Nervousness and anxiety
4. Inability sleep, as the mind is always excited
5. Increased appetite (sometimes despite weight loss) due to higher metabolism
6. Irregular menstrual cycles
7. Palpitations (rapid, loud heartbeat)
8. Irregular heartbeats (tachyarrhythmia)
9. Fine tremors of the extended arms
10. Breast enlargement in men, known as gynecomastia
11. Extreme moodiness, causing irritability and anger
12. Inability to focus and concentrate
13. General fatigue and shortness of breath with any exertion
14. Increased frequency of bowel movements

In addition, the eye symptoms are quite diagnostic including:

1. Protrusion of the eyes (exophthalmos), giving an impression that they are going to fall out
2. Double vision
3. Excessive tearing
4. Increased irritation in the eyes

Diagnosis: The first symptom would be the presence of an enlarged thyroid gland (front of the neck above the collarbone), and the some of the above symptoms would be present.
In addition, tests to check for thyroid gland functioning including T3 and T4 levels would reveal increased amounts of hormone in the blood stream.
As a confirmatory test, the radioactive iodine uptake test also is done, which will indicate increased uptake by the thyroid gland. This indicates that the gland is functioning at an increased pace and requires additional iodine for the production of thyroid hormones.

Treatment: There are two approaches to it, one to control the symptoms and the other to control the thyroid gland per se.

1. Beta blockers are very useful in controlling rapid heart rate and anxiety.
2. Prednisone may be used to control eye irritation and swelling
3. Antithyroid drugs are used to control the production of thyroid
4. Radioactive iodine is given orally to control excessive thyroid production
5. In severe cases, thyroid gland may be surgically removed partially or completely

Graves’ disease is not life-threatening and once symptoms are controlled, the patient’s quality of life improves drastically. If you wish to discuss about any specific problem, you can consult a endocrinologist.

Cancer can affect even small glands like the adrenal glands. Adrenal glands are responsible for the production of hormones like cortisol and aldosterone. These glands are located above the kidneys and have two parts; the cortex and the medulla. Adrenal cancer generally affects the cortex of the adrenal glands. This type of cancerous tumour is rare and can be difficult to diagnose.

Most adrenal cancer symptoms are triggered by an excessive production of estrogen and androgen. Symptoms can also be caused by the pressure put on other organs by the tumour. Adrenal cancer symptoms are most easily noticeable in children as this is the stage where the body is changing and developing. Some of these symptoms are:

1. Facial hair growth
2. Excessive pubic and underarm hair
3. An enlarged penis or clitoris
4. Early onset of puberty in girls
5. Development of enlarged breasts in boys

Symptoms of adrenal cancer in adults includes:

1. Excessive weight gain in the abdomen and above the collar bone
2. High blood pressure
3. Irregular menstruation
4. Easy bruising
5. Depression
6. Frequent urge to urinate
7. Muscle cramps

Additionally, men with adrenal cancer that causes excessive estrogen production may notice an enlargement of breast tissue and tenderness in the area. Women suffering from excessive androgen production triggered by adrenal cancer may notice their voice deepening and facial hair growth. In most cases, adrenal cancer symptoms in women do not appear until the tumour presses on other organs. This includes symptoms like pain around the tumor, a feeling of fullness in the abdomen and difficulty eating because of this feeling.

The cause of adrenal cancer has not yet been determined, but conditions such as Beckwith-Wiedemann syndrome, Li-Fraumeni syndrome, familial adenomatous polyposis and multiple endocrine neoplasia can increase a person’s risk of suffering from this disease. A thorough physical examination and a detailed medical history is required to diagnose this disease. The doctor will also need a blood test and urine test. Additional tests that may be required include:

1. Biopsy of the tumor
2. CT scan
3. MRI scan
4. PET scan
5. Adrenal angiography

Adrenal cancer can be cured if diagnosed in its early stages. There are three types of treatment for adrenal cancer; surgery to remove the adrenal gland, chemotherapy and radiation. However, adrenal cancer can recur and hence it is important to schedule and maintain regular check-ups with your doctor.

The body produces a number of chemicals called hormones which are essential for the regulation of various functions including growth and metabolism. These hormones are produced by endocrine glands which are located in various parts of the body. One such important gland is the pituitary gland which produces the important growth hormone. This is essential for regulating optimal growth during the growing years and for maintaining proper amounts of body fat, muscles, and bones in the later years of life.

Causes: Deficiency of the growth hormones can occur due to a number of causes, some of which are listed below. It can be congenital (present at birth) or acquired later in life.
The congenital issue could be due to problem in the pituitary gland structure, leading to complete absence or reduced secretion of the hormone.
With age, there is a decrease in the amount of secretion. However, infections, injuries, brain tumors, surgery and radiation can also lead to altered amounts of secretion.

Symptoms: While growth hormone deficiency can occur at any age, symptoms differ depending on the age when the deficiency sets in.
In the early ages:

• Lower rate of growth for a given age
• Delayed developmental milestones
• Delayed onset of puberty
• Short stature/reduced height
• Younger looking compared to other children their age
• Fat deposition around the waist
• Delayed dental development

When the deficiency sets in during the later years, there is

• Low energy levels, constant tiredness
• Decreased strength
• Decreased exercise tolerance
• Decreased overall muscle mass
• Thin and dry skin
• Increased fat deposition and weight gain around the waist
• Changes in social behavior including alternate cycles of anxiety and depression
• Lack of motivation
• History of pituitary tumors
• High levels of fat and cholesterol

The diagnosis depends on the age of the person

• Blood tests are carried out to check the hormone levels in circulation
• In children, in addition to the hormone levels, x-rays to see the status of growth plates is very helpful.
• An insulin hypoglycemia test where insulin is given intravenously to see the levels of the growth hormone after 30 minutes.
• Total cholesterol levels, low-density lipoprotein (LDL) cholesterol, apolipoprotein B, and triglyceride levels can be used to supplement the above tests.
• CT scan and/or MRI of the brain may be needed if tumors are suspected.

Treatment: Once diagnosed, replacement therapy is given as shots a few times a week under the skin. This restores normal growth and helps in controlling the symptoms in adults too.
In cases of tumor, radiation or surgery may be required, but most cases are managed with hormone replacement.
Watch out for the symptoms if your child has delayed developmental milestones and early intervention can help restore growth and function to normal levels.

If you wish to discuss about any specific problem, you can consult the doctor and ask a free question.