Nocturnal Hypoglycemia caused by Addison's Disease

Hypoglycemia is a condition where a person's blood glucose level is low, usually under 60 milligrams per deciliter. It is a severe condition as it might cause seizures, coma, permanent brain damage and even death in some extreme cases. There are several symptoms such as extreme hunger, lightheadedness, and can also cause one to shiver. It is known that Addison's disease could cause hypoglycemia. This is because the liver or more specifically adrenal cortex is damaged therefore there is a decreased process of gluconeogenesis and increased-mediated glucose uptake by the skeletal muscle. However there is a way to prevent this by using a method called "Continuous Glucose Monitoring System" (CGMS). It had been proven that hydrocortisone level will affect the blood sugar level. By monitoring the glucose level and changing the time in which the victim take his or her dose of hydrocortisone.

Hypoglycemia by Cody Cove (5th October 2013) retrieved on 25th July 2014 from "http://blogs.longwood.edu/hypoglycemia/2012/10/05/hypoglycemia-by-cody-dove/"

NCBI "Nocturnal Hypoglycemia Identified by a Continuous Glucose Monitoring System in Patients with Primary Adrenal Insufficiency (Addison's Disease)" Retrieved on 25th July 2014" http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3338953/?report=classic"

Cornell education "Hypoglycemia" retrived on 25th July 2014. "https://ahdc.vet.cornell.edu/clinpath/modules/chem/hypogly.htm"

Addison's Disease-- Secondary Adrenal Insufficiency

Addison's disease may sometimes afflict people due to other reasons, such as another illness that they are going through/went through. This is secondary adrenal insufficiency, where the disease has its point of causality in another disease or illness. Secondary adrenal insufficiency is caused by a lack of the CRH or ACTH, which can be attributed to several reasons, such as stoppage of corticosteroid medication.

Some people may be required to take synthetic(artificially produced) glucocorticoid hormones known as cortiocosteriods to treat inflammatory diseases such as rheumatoid arthritis. However, taking these hormones for a prolonged time period causes the adrenal glands of these people to produce less of their natural hormones like cortisol, resulting in Addison's disease. To give the adrenal glands time to regain their normal functions, the dosage of the medication is reduced slowly, but even with such measures these people still stand a chance of getting the disease.

Another group of people at risk of getting Addison's disease is those who have had their pituitary tumors(a growth on their pituitary gland like the adrenal gland) removed surgically to cure Cushing's syndrome, a form of cortisol related disorder in which too much cortisol is produced for a prolonged period of time. When the tumors are removed an extra source of ACTH is gone, and the adrenal glands would be unable to produce cortisol normally for a period of time, of which a replacement hormone must be consumed as a form of medication. Taking an inadequate dosage of the hormones can then lead to Addison's disease.



Angela (24 April 2013), Learn about Cushing's syndrome, 'Cushing Syndrome's symptoms", retrieved 24 July 2014 from <http://www.neurobodyfit.com/learn-about-cushings-syndrome/>

Other causes of secondary adrenal insufficiency include infection of the pituitary, removal of parts of the hypothalamus and radiation treatment of pituitary or nearby tumors.


Healthfoxx(n.d), Adrenal Insufficiency(Primary & Secondary)-- Symptoms, Treatment, Diagnosis, retrieved 24 July 2014 from <http://healthfoxx.com/adrenal-insufficiency-symptoms-treatment-diagnosis/>

National Endocrine and Metabolic Diseases Information Service(14 May 2014), Adrenal Insufficiency and Addison's Disease, NIH Publication No. 14-3054, retrieved 24 July 2014 from <http://endocrine.niddk.nih.gov/pubs/addison/addison.aspx#causes>

Addison's Disease-- Diagnosis and Treatment

Addison's Disease can be diagnosed with the following methods:

1. Blood tests --> Allows a review of blood content
2. Physical examination --> Look out for physical symptoms such as hyperpigmentation
3. Measure hormone levels in blood and urine after the patient is given ACTH --> ACTH is a hormone which when activated in the brain causes the adrenal gland to produce more cortisol. Measuring ACTH can help to diagnose if the Addison's disease is caused by a malfunction in the brain or the adrenal glands. Scans such as X-rays and CT scans can also be used to pinpoint the cause of he disease.

K Hayat(31 August 2012), blood-test, retrieved 18th July 2014 from <http://medimoon.com/2012/08/blood-test-may-tell-you-when-you-will-experience-menopause/> 

While Addison's disease cannot be prevented, it is not incurable and with proper treatment patients can still live normal lives. Addison's disease is a disease of hormonal deficiency, hence one of the most straightforward ways to treat the disease is simply getting patients to consume the hormones as a form of medication. This can be done by the consumption of pills containing hydrocortisone to treat cortisol deficiency or pills containing fludrocortisone acetate, a type of steroid hormone(special type of hormone), to treat aldosterone deficiency. The doses are increased in times of stress and illness/injury. Taking in these hormones helps to make up for the patient's lack of these hormones, so that the body's normal regulatory and metabolic process can carry on as normal. These medications must be taken on time and the doses must not be missed, for this will mean that the patient will once again lack cortisol/aldosterone and suffer from the effects of Addison's disease. Patients should also monitor their health to ensure they get sufficient doses of medication and that the disease's effects on them are minimal.

Future treatment methods of Addison's disease include involving 'physiological' time replacement therapy, hormone replacement therapy and the utility of adding adrenal androgens which are important for libido, mental capacity, muscle strength and bone density for female patients, which give females a better form of treatment.

For a patient suffering from an Addisonian crisis, doctor-prescribed injections of salt, fluids and glucocorticoids may be given as immediate treatment.

Whitney(20 November 2012), Fludrocortisone, retrieved 18th July 2014 from <http://s2.hubimg.com/u/1242809_f260.jpg>

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David. T Derrer, MD (29 March 2014) Understanding Addison's Disease -- Diagnosis & Treatment, retrieved 18th July 2014 from <http://www.webmd.com/a-to-z-guides/understanding-addisons-disease-basics>

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Addison's disease-- Symptoms and effects

Both branches of Addison's disease lead to variety of negative effects on the body, and these effects can also be seen as symptoms of the disease. The following are the symptoms of Addison's disease that the patients go through and can be used to diagnose the disease in a person:

1. Chronic(serious) fatigue and weakness in the muscles
2. Loss of appetite, frequent digestive problems, unexplained weight loss without diet/exercise
3. Low blood pressure/ High blood pressure
4. Frequent dizziness and fainting
5. Skin becomes blotchy, freckled and darkened especially on parts of the body frequently exposed to sunlight(Hyperpigmentation)
6. Darkening of the gums
7. Possible hair loss
8. Serious hypoglycemia(low blood sugar level)
9. Nausea(urge to vomit), vomiting and diarrhea
10. Inability to cope with stress
11. Moodiness, easily irritated, depression, racing thoughts and scattered thinking
12. Low tolerance to cold or heat
13. Salt cravings(Cravings for salty food)
14. Sleep abnormalities 
15. Anxiety
16. Heart palpitations 

Hyperpigmentation

medindia (n.d) Skin Pigmentation Disorders, "Hyperpigmentation", retrieved 21st July 2014 from <http://www.medindia.net/patients/patientinfo/skindisease-skin-pigmentation-disorders.htm>

Darkening of the gums

Et.al(n.d) Addison's Disease retrieved 21st July 2014 from <http://www.studyblue.com/notes/note/n/pigmented-and-discolored-soft-tissue-lesions/deck/1827448>

However, these symptoms may not show up immediately on a patient as Addison's disease progresses at a very slow rate, but they may appear after the person's body enters a threatening situation such as another illness, surgery or being seriously injured. This may trigger something known as an Addisonian crisis, which can lead to fatality if not treated fast. 1 in 4 patients discover their affliction with Addison's disease through this. The following are symptoms of an Addisonian crisis:

• Sudden penetrating pains in the lower back, abdomen or the legs
• Severe vomiting, diarrhea leading to dehydration
• Low blood pressure
• Loss of consciousness
• Eventual kidney shutdown

Et.al(n.d) Addison's Disease retrieved 16th July 2014 from <http://www.studyblue.com/notes/note/n/chapter-65/deck/2478097>

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K Lynette( 30 January 2013), Patient Information: Adrenal Insufficiency(Addison's disease)(Beyond the Basics), retrieved 16th July from <http://www.uptodate.com/contents/adrenal-insufficiency-addisons-disease-beyond-the-basics>

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Addison's Disease-- Cortisol Insufficiency and Aldosterone insufficiency(Primary Adrenal Insufficiency)

There are 2 branches of Addison's disease that are caused by a Primary Adrenal Insufficiency. One of these branches is cortisol insufficiency, which is the lack of cortisol hormones in the body. Cortisol is an essential hormone to the body with two major functions, the first being to help the body respond to stress and to trigger a 'fight or flight' reaction which helps your body react appropriately to a dangerous situation and survive such as coming face to face with a venomous snake, and the other is to help the body maintain homeostasis, a state of which the body's systems are regulated to a certain optimal state for its survival, by regulating the body's use of carbohydrate, protein and fat, helps to maintain blood pressure and cardiovascular function and also controls inflammation in the body. Without enough cortisol, the body will struggle to maintain homeostasis, resulting in several hazardous and even life threatening consequences, and the body will also face difficulty dealing with stressful situations appropriately.

H Brian( 15 January 2012), B) A look at cortisol, retrieved 16th July 2014 from <http://ultimatecityfitness.com/wp-content/uploads/2012/01/cortisol.jpg>

The other branch of Addison's disease is aldosterone insufficiency, which is a lack of aldosterone hormones in the body. Aldosterone is used by the kidneys to regulate the salt and water levels in the body, the main way of maintaining blood volume to keep blood pressure under control. Without enough aldosterone, the kidneys are unable to keep salt and water levels in balance, resulting in poor blood volume and blood pressure control, which can have several detrimental effects on the body.

                                
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H Brian( 15 January 2012), Cortisol-Don't let it stress you out, retrieved 16th July 2014 from <http://ultimatecityfitness.com/wp-content/uploads/2012/01/cortisol.jpg>
K Lynette( 30 January 2013), Patient Information: Adrenal Insufficiency(Addison's disease)(Beyond the Basics), retrieved 16th July from <http://www.uptodate.com/contents/adrenal-insufficiency-addisons-disease-beyond-the-basics>

Introduction to Addison's Disease

Addison's Disease is a rare hormonal disorder that afflicts about  1 in 100000 people. Addison's disease is not a terminal condition, most people who have it can live normal lives so long as they take their medication. Many of our body's important biological processes are regulated by chemical messengers known as hormones, and in the case of people afflicted with Addison's Disease, there are two branches of the disease, one being that their body does not have enough of a hormone known as cortisol and another being a lack of a hormone known as aldosterone, as a result of a deficiency in a part of the body known as the adrenal glands.


Behling J(18 March 2013), Adrenal glands, retrieved 15 July 2014 from <http://essentialsurvival.org/natural-solutions-adrenal-fatigue/>