Addison's Disease and Infections????

[shescoolie]

Hi Everyone,

So I asked this question today in class and could not get a clear answer from neither the professor or my classmates. My question is why specifically do we need to protect Addison's patients from infection? Why is there such an emphasis placed on preventing infection? I understand that there is a hyposecretion of glucocorticoids and mineralocorticoids, but I don't see where these two hormones directly affect immunology or infection control. I've read and read and all my books say that we need to prevent infection, stress, fluid and electrolyte imbalance, but no reason for infection control. PLEASE HELP!

[Boog'sCRRN246, RN]

Treatment of Addison's usually involves replacement of cortisol and aldosterone, which are steroid hormones. Long-term use of steroids masks the signs/symptoms of infection, so I would think you would need to decrease their risk of acquiring an infection as much as possible.

[shescoolie]

Treatment of Addison's usually involves replacement of cortisol and aldosterone which are steroid hormones. Long-term use of steroids masks the signs/symptoms of infection, so I would think you would need to decrease their risk of acquiring an infection as much as possible.[/quote']

OMG thank you so much! I totally understand it now! That makes so much sense.

[Boog'sCRRN246, RN]

Hopefully if there is a better, more precise answer, someone will come along and chime in!

[kgh31386, BSN, MSN, RN]

Exactly, steroids will reduce immune response.. Increasing risk for infection, and masking inflammation and symptoms of infection

[vs2kojo]

Hi!

Addisons disease comes in two forrms. Primary adrenal insufficiency is simply non functioning adrenal glands due to infection (tuberculosis, fungi), autoimmune diseases.... It has to be bilateral since one adrenal gland is enough for full function. In this case you need to substitute for both glucocorticoid (cortisol) and mineralcorticoid (Florinef) insufficiency. Secondary adrenal insufficiency is when the drive (ACTH - adrenocorticorophe hormone) from the pituitary gland is failing while the adrenal grand is basically healthy. Here you only have to substitute for glucocorticoid insufficiency only since mineralcorticoids are stimulated from the kidneys through renin-angiotensin system whitch does not involve the pituitary gland.

Notice that I used the word substitute instead of treatment. Subtitution is to give doses that closely mimic the amount and daily variation of the hormone in question. Patients that are optimally substituted can have completely normal life. They do not develop symptoms and signs like patients who are treated with supraphysiological doses (like treatment for asthma, RA...) with thin, dry skin, buffalo hump, elevated glucose levels... However the need for cortisol is increased in mental and physical stress, like physical exercise, interview for work, infection, trauma... In that case patients are told to double the dose of cortisol for every degree celsius over 38. Some patients take extra cortisol before aerobics.

The immune system is effected by cortisol levels. However correctly substituted, a patient with Addison's is healthy as far as the body knows - cortisol levels are the same as without Addison's. The trick is to elevate cortisol intake according to the need for it when something happens, like an infection. The risk for infection is however not increased whatever people say. It is more of a theoretical question. The dagerous part is if you don't take extra cortisol when needed. Specially dangerous is when you throw up all your cortisol tablets. That is a potentially life threatening situation (mainly loss of blood pressure) that has to be addressed quickly by visiting nearest hospital for intravenous cortisol infusion. Also it may take longer time to recover if the cortisol dose is too low.

What i mean is that patients with Addison disease are not prone to infection. It is the other way around. They can be more much sick and perhaps not recover if the cortisol dose is not increased enough in case they get an infection.

What cortisol actually does in the body is not possible to tell since it does different things in different cells/tissue. Think of it as at hormone that helps you handle stress in life. That is why too much stress leads to early death. You go on overdrive and wear out your cells.

Best wishes

Josef.