Questions posted in the The Addiction Forum have been answered by Steven Adelman, M.D. and by Richard C. Bozian M.D. F.A.C.P. of Harvard Vanguard Medical Group.

Question Title: Addison's Disease--alternative approach to cortisol

Forum: The Addiction Forum
Topic: Misc


Drs: I know this is not an Endocrinology section, but there is none on this menu, and the General category is patient-to-patient and I want to discuss with a doctor. WOULD YOU KINDLY DIRECT THIS MESSAGE TO THE APPROPRIATE DOCTORS? IN ADDITION, PLEASE ASK WHOEVER RECEIVES THIS MESSAGE TO DIRECT HIS/HER REPLY TO THIS PRESENT FORUM CATEGORY OR POST A LINK HERE SO I CAN FIND WHERE MY ANSWER IS GOING TO BE? Thank you.

1.I have a diagnosis of Addison's Disease with a possible diagnosis of "polyglandular syndrome" (not sure which type, I or II). The only presenting symptoms were chronic fatigue and diminished sexual interest. Adrenal antibodies--normal, thyroid antibodies--normal. No presentation of autoimmune activity in the blood. No test performed for 23-hydroxylase autoimmune antibody. CT scan showed adrenal gland in normal position and size. No masses, no evidence of calcification. The surmise is that this is an autoimmune etiology. There is a strong suspicion of early testicular failure. The recommendation was for 20-30 mg. Cortef for now, and possibility of testosterone.
2.My symptoms remained much the same until a few weeks ago when I suddenly experienced a drop in blood pressure. It was at this time that the family physician recommended that I certainly begin the cortisol which I had not yet taken. Nevertheless, I have chosen not to and am taking small quantities of salt and licorice root temporarily to maintain blood pressure, which is working.
3.My questions are these: Is there another alternative to taking hormones? My anxiety is that my adrenal gland simply will stop functioning if I do, and I will be totally dependent for survival on the medication. I would prefer some other method of stopping the auto-immune process instead of treating the symptoms; and of NOT atrophying the function of my own adrenal gland. I am also keen to know if there is any other credible possibility--other than auto-immune--for my primary adrenal insufficiency, given the fact that no blood findings occurred and the CT scan was normal. Only the ACTH challenge test was positive (about l92 points where 525, I believe, is low normal range).
Would an MRI reveal if my adrenal cortex was damaged or not? Surely, if the cortex is intact, I do not have an autoimmune disorder but a functional one--yes? What about the possibility of a metabolic disorder that produces low adrenal response? I recently had a blood test that shows liveblood. It did not take a microbiologist to know, from what I saw, that something is awfully wrong with my blood! It took a very long time to find a normal, spherical, dark-centred, moving blood cell. The vast majority were crumpled, stuck together, looked like lemons with mutltiple stemps, and in all resembled a scrapyard--no exaggeration! Certainly, this is a pre- or actual-disease condition. If I were an immune cell, I would look at that and want to get rid of it, too! What if my adrenal cortex has cells of a deformed kind and are being bombarded as part of an attempt--not to destroy normal tissue--but to rid the adrenal gland of abnormal cells--or, something IN normal cells? The key would be, would it not, to alter my blood back to normal, or rid the cells of the invading whatever? I also have poor carbohydrate metabolism--which is causing low blood sugar not yet diabetic. I understand Addisonians sometimes get diabetes. Point is: IS THIS ADDISIONS OR A METABOLIC DISORDER WHICH SHOULD BE TREATED AT THE CELLULAR LEVEL WITH THE PROPER ELECTROLYTES, FOOD, SUPPLEMENTS--and adrenal function might be restored or at least not further destroyed? HELP. THANK YOU.


_______

I will forward your query to the MedHelp staff.

Steve Adelman, M.D.++


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