Dr. Ron’s Research Review – February 19, 2014

© 2014

This week’s research review focuses on Sub-clinical Addison's Disease

As autoimmune adrenalitis is fast replacing tuberculosis as the most common etiology cause of adrenal insufficiency, subtler forms of the same are being recognized as subclinical Addison's disease. (Baruah 2012)

The natural history of Addison's disease can be divided into four distinct stages, each characterized by documentable biochemical changes, such as,

Stage 0: Normal,

Stage 1: Increase plasma renin activity (PRA) and normal or low serum aldosterone levels and appropriate response to ACTH,

Stage 2: Low cortisol response to ACTH,

Stage 3: Increase plasma ACTH, basal serum cortisol at lower end of normal, and absent cortisol response to ACTH,

Stage 4: Low serum or urinary cortisol along with highly elevated plasma adrenocorticotropin (ACTH) with evident features of adrenocortical failure.

Stage 1-3 would fall into sub-clinical category, while stage 4 is by and large clinical.

Emotions

Patients with Addison's disease have not only increased levels of anxiety and fear, and over-reaction to stimuli, but decreased performance efficiency and need for social contact as well. Such psychological characteristics may result in difficulties in doctor-patient communication, aggravation of patients' feelings, limitation of patients' involvement in therapy, and, finally, a decrease the effectiveness of therapy. (Warmuz-Stangierska, Baszko-Blaszyk et al. 2010)

Dr. Ron


Articles

Sub-clinical addison's disease

         (Baruah 2012) Download

As autoimmune adrenalitis is fast replacing tuberculosis as the most common etiology cause of adrenal insufficiency, subtler forms of the same are being recognised as subclinical addison's disease. In this article, we review what is known about this entity till date.

Emotions and features of temperament in patients with Addison's disease

         (Warmuz-Stangierska, Baszko-Blaszyk et al. 2010) Download

INTRODUCTION: Patients with Addison's disease experience many somatic and psychic changes, which decrease their quality of life. The aim of the study was to evaluate the "psychological equipment" of these patients to cope with stress connected with this chronic disease and the challenge of constant treatment. MATERIAL AND METHODS: Fifteen patients (13 female, 2 male) were included in the study. Standard psychological tests were used to assess anxiety, temperament, depression, and emotional intelligence. RESULTS: The results show that patients with Addison's disease have not only increased levels of anxiety and fear, and over-reaction to stimuli, but decreased performance efficiency and need for social contact as well. Such psychological characteristics may result in difficulties in doctor-patient communication, aggravation of patients' feelings, limitation of patients' involvement in therapy, and, finally, a decrease the effectiveness of therapy. CONCLUSIONS: The temperamental characteristics and personal traits of patients with Addison's disease seem not to be useful in stressful events, and psychological support can be helpful in the effective therapy of these patients. (Pol J Endocrinol 2010; 61 (1): 90-92).


References

Baruah, M. P. (2012). "Sub-clinical addison's disease." Indian J Endocrinol Metab 16(Suppl 2): S176-7. [PMID: 23565372]

Warmuz-Stangierska, I., D. Baszko-Blaszyk, et al. (2010). "Emotions and features of temperament in patients with Addison's disease." Endokrynol Pol 61(1): 90-2. [PMID: 20205110]