Talk:Addison's disease/Archive 1

Archive 1

Addisonian Crisis

I know this probably shouldn't go here, but I couldn't resist as people knowledgable in this area will read this. I have gone through some chest/upper stomach pains, dizzyness, fainting (this is whilst driving btw) and then finding myself really hot/cold needing the aircon on full and my face is full white - is it possible that it could be a result of me currently tapering my prednisolone dosage?!?! I have been on pred for the past 6 months, and also 6 months around 2 years ago. I began tapering about a month or two ago, from 25mg to 12.5mg to 10mg and currently at 7.5mg. Any suggestions would be greatly appreciated. Cheers. [User:Timeshift9|Timeshift]] 15:33, 13 May 2006 (UTC)

• The only answer I can think of is, consult your physician who prescribed it and instructed you on a tapering schedule. Plerase note: Wikipedia is never a substitute for professional advise, i.e. your General Practitioner. Nomen Nescio 15:28, 13 May 2006 (UTC)

Vandalism?

This statement in the current version seems likely to be vandalism to me. Can some experienced wikipedian please check the article and edit as necessary? 132.239.58.113 20:18, 15 November 2006 (UTC)sarah

Hereditary

I removed a claim that Addisons Disease is "never hereditary". My reading suggests that some causes are hereditary, and the article Autoimmune polyendocrine syndrome, which is a major cause of the disease clearly shows that some forms of the syndrome are a result of inherited mutations. Robertbrockway 05:23, 10 October 2005 (UTC)

As a recently diagnosed addisonian, with a mother who also has the disease, I can assure you that it is possible for immediate family members to each be affected. I would be interested to know, though, the piece of research that mentions the chances of this as 2%? Rooneyot 23:08, 15 December 2006 (UTC)

Vigilance Prime questions

(Since I had so many things to ask on different topics, I thought sub-sectioning them would be best for purposes of readability.)

Relationships and other sections?

--- I have seen in my research online that most articles speak at least briefly to the risks associated with Addison's and buth surgery and pregnancy, but I don't see either mentioned here so I wondered if they both should be. Perhaps an entire main section on "Addison's and daily life activities."

--- Also, I have searched and searched (online, using Google as my launching point) and have found nothing on Addison's impact on relationships, to include friendships, business dealings and intimacy/marriages (and the like). I was wondering 1. if this would make a worthwhile addition to this article and 2. what some common experiences and observations are regarding these from those who know firsthand: those with Addison's.

--- VigilancePrime 11:37, 5 July 2006 (UTC)

Like any chronic condition, there can be broad consequences. Fatigue can be a feature at times, even with optimal treatment. Stress is harder to manage. But I find diabetes to have a much larger impact on my life on a day-to-day basis. Of course, untreated Addison's impact on everything is profound. Before diagnosis, I was unable to even sit up for more than a couple hours. Bob Kerns 21:03, 9 March 2007 (UTC)

As someone that has had Addison's Disease for four years now it has not changed my life at all. The only times it has affected my life are during times of more stress than normal such as being sick or when you are "stressing" out over something. My doctor has advised to double the normal the daily dose of prednisone and florinef in those situations. Checkmate911 14:13, 25 November 2006 (UTC)

Accuracy of Wikilinks

--- Also, I saw that the symptom "Loss of consciousness" WikiLinks to "Coma." I think this may not be best as a coma is significantly different (and far more severe) than losing consciousness. Yes, loss of consciousness may lead to a coma, but a coma is a different phenomenon and losses of consciousness usually are not coma-producing. Is there a better way to WikiLink these? (Also, if Coma specifically is a "symptom" of Addison's, it should be stated as such!) VigilancePrime 11:37, 5 July 2006 (UTC)

Changed the loss of consciousness link to Syncope. 23:57, 27 October 2006 (UTC)~~

Honest question

--- Not to be bothersome with all this, but I wondered something and thought this the best place to find out. I have found that most of the articles and research I have come across refers to persons with Addison's Disease as "Addisonians." I was wondering if this is an accepted term among those with Addison's? (For instance, members of the Church of Jesus Christ of Latter-Day Saints are often called, simply, "Mormon," but for a long time this term was not used by LDS members and was often considered offensive, but now is becoming accepted, even used in a recent LDS television ad - as a parallel example.) VigilancePrime 11:37, 5 July 2006 (UTC)

--- By the same token, if any of my wording in the additions to this article are less-than-ideal (for instance, to avoid repetition, I vary terms and use words such as "afflicted," "sufferer," and "Addisonian"). PLEASE let me know if any of these are considered improper and/or derogatory in any way. VigilancePrime 11:37, 5 July 2006 (UTC)

Hydrocortisone is Cortisol

Cortisone is not cortisol, it is a less active metabolite of it. Cortisone injections are used for joint injuries, to temporarily reduce inflammation. These injections are intramuscular, and are not the same thing as the intravenous hydrocortisone/cortisol used for Addisonian crises. Please don't mess with medical terms unless you've researched them first.

That said, I'm of two minds as to whether we should use the term hydrocortisone at all. It's more readily recognized than cortisol, and seems to be used for pharmacologic cortisol. The problem is that from what I've seen, hydrocortisone is used mostly for anti-itch and anti-allergy applications, rather than endocrine ones. I'm tempted to just change all references to cortisol, in order to make it clear that we're talking about in a purely endocrine context, not as allergy medicine. Kajerm 21:56, 19 November 2006 (UTC)

As this confusion is very prevalent, I think it essential to mention and clarify. Hydrocortisone is used for endocrine and rheumatologic purposes, but of course, topical hydrocortisone is more familiar to most people these days. Still, I think it makes sense to follow standard usage, and use the term "hydrocortisone" when speaking pharmacologically, and "cortisol" when speaking physiologically. The clarification should specifically indicate that is how the terms are used.

It would be worth mentioning the relationship of cortisone to cortisol, particularly since cortisone acetate has been (and rarely, still is) used as treatment for Addison's. There's a pair of enzymes, 11β hydroxy-steroid dehydrogenase, types 1 and 2, which interconvert between cortisol and cortisone.

Prednisone and other glucocorticoid steroids are also used. Prednisone is similar to cortisone, and is converted by the same enzymes to prednisolone, which is the active drug.

BTW, the IV/injectible hydrocortisone used is generally hydrocortisone sodium succinate (generally, brand-name Solu-Cortef), an ester of cortisol, which quickly converts to cortisol. Methylprednisolone sodium succinate (Solu-Medrol) and dexamethasone are also used.

The article could use more pharmacology and physiology links to Wikipedia content.

Also, a better description of the ACTH/synthecin stimulation test used to diagnose the condition. And the term "adrenal insuufficiency" needs to appear, as that's the general descriptive term. Thomas Addison's original 1855 paper can be found (in scanned form) at http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1033929; a link would be appropriate.

You can find a lot of info in my Furl archive: http://www.furl.net/members/rwkrwk.

No mention of DHEA, which is also generally missing in primary Addison's.

Also, this should be hooked in with the Wikipedia:WikiProject_Medicine project. That's in addition to the canine connection. The canine connection is important because of its higher degree of prevalence in various breeds gives us a lot more information on the disease. (Rats don't help much -- they use corticosterone instead of cortisol).

Bob Kerns 21:27, 9 March 2007 (UTC)

In Dogs

I'm not a regular Wikipedia updater, but here's something for research. My dog, Fraiser, has Addison's. He takes predisone, and another medication whose name I cannot recall, but both are steroids. While addison's is treatable, it is not curable in dogs, and therefore he must remain on medication for the rest of his life. Due to the medicine he is taking, it is likely that he will not live as long as he otherwise would, as the medicine leads to other problems, specifically kidney failure later in life.

Also, while on his medication, he acts perfectly normal and active. There is no hint that he has addison's. That may also be worth noting. And our vet advised that he take a calcium suppliment, as the medicine also affects those levels.

Again, I am only speaking for my dog, but I know the disease is rare and the information may be useful. As far as I understand, these things about Fraiser are common to dogs with the disease. Thanks. Dave

Yes, those sound the same as my dog, Dottie. She was diagnosed with Addison's less than a year ago after having a near-fatal Addisonian crisis. But after tha one event she hasn't changed a bit. We just have to keep an eye on her, and if she starts acting weird in any way we take her to the vet immediately. She also has to go every month to get shots and tests done to make sure everything is running smoothly, which it has so far. I just put this page on my watchlist so I might try adding to the Canine section a little. Konman72 07:39, 26 July 2006 (UTC)

My JR terrier, Digger, has had Addison's since he was 3 years old. He is now 11 years. Since his monthly DOCP shot was expensive ($85) I got the medication and gave him the shots myself. Now instead of $85 for the vial I am paying $175 per vial. I need to find some less expensive source of the medication. Otherwise he is the joy of my life and the perfect dog. Mary, Boulder, Colorado. — Preceding unsigned comment added by 71.56.237.62 (talk) 01:05, 20 April 2007 (UTC)

Copper

Somewhere in my memory I remember reading some mention of copper being retained in the body of Addison's, instead of being excreted, and builds up in the body. However, there is no mention of this in the article-- am I thinking of Cushing's or is this just something my mind made up? Curious. 217.166.94.1 07:53, 3 May 2007 (UTC)

You may be confusing Addison's with Wilson's disease. JFW | T@lk 11:17, 17 June 2007 (UTC)

It is potassium being retained instead of copper. Checkmate911 11:54, 13 July 2007 (UTC)

Jane Austen

I believe this line should be removed: "Jane Austen is thought to have been another, although the disease had not been described during her lifetime." This is just an unproven theory that has been contradicted, for example: http://mh.bmj.com/cgi/content/short/31/1/3 - Med Ethics; Medical Humanities 2005;31:3-11. Somno 08:14, 26 October 2007 (UTC)

External links

External links to patient support groups (especially online chat boards), blogs, and fundraising groups normally not accepted on Wikipedia. Also, to prevent a proliferation of links, it's good to avoid more than one link to any website. Please read the external links policy and the specific rules for medical articles before adding more external links. WhatamIdoing (talk) 00:41, 13 January 2008 (UTC)

"Adrenal Crisis"

"Adrenal crisis" is referred to in this article as an "addisonian" crisis, but it does not occur only in the case of full-blown, continual addisons disease. While it may be helpful to call it an addisonian crisis in this article, I think it should be referred globally as an "adrenal crisis," as that is what I have seen to be the medically correct term.

I think it would be helpful to have an "Adrenal Crisis" article, as per this MedlinePlus article http://www.nlm.nih.gov/medlineplus/ency/article/000357.htm . Thoughts?

Quarkfactor (talk) 23:00, 28 January 2008 (UTC)

request pic of JFK

request pic of JFK. Many should be available in the public domain. Tkjazzer (talk) 00:08, 31 March 2008 (UTC)

Improvements

Much of the article presently lacks sources. Has anyone seen a good clinical review recently that could be used to support the numerous numerical claims made in the article? JFW | T@lk 11:17, 17 June 2007 (UTC)

PMID 17135373 - psychiatric presentations reviewed

PMID 11443143 - JCEM review (probably the most authoritative)

In addition to adding those sources, maybe we can include some of the physiological causes of some of the symptoms ie. low blood pressure is due to inability to retain sodium and water. there are many others that are easily explainable such as increased pigmentation due to overproduction of alpha MSH (melanocyte stimulating hormone) as a by product of ACTH overproduction. Mrormisterhenry (talk) 03:18, 20 February 2008 (UTC)

That definitely belongs in the "pathophysiology" section. JFW | T@lk 15:59, 1 April 2008 (UTC)

"prereq for aids?"

what does this mean in the opening paragraph??? —Preceding unsigned comment added by 168.7.254.186 (talk) 18:01, 21 January 2009 (UTC)

Possible Psychological Cause

The reference to "Possible psychological causes" is not cited and is medically improbable, at best. It should be removed if appropriate support is not found. —Preceding unsigned comment added by 24.186.250.26 (talk • contribs) 05:08, 8 March, 2006 (UTC)

Severe emotional malnutrition. Anger at the self.

What case studies are there to back these assertions? Are these even generally recognized diagnostical categories? Sounds like pseudo-psycho mumbo-jumbo. —Preceding unsigned comment added by Jlowery (talk • contribs) 19:54, 8 March, 2006(UTC)

I have put the unreferenced template on this section. If no one comes up with anything, please delete the section. Celefin 18:52, 9 March 2006 (UTC)

Chronic stress can and does precipitate Addison's. I suppose emotional malnutrition and anger at the self would be two causes of that. Psychological factors certainly do deserve a mention. Zinc deficiency and copper toxicity would be two common concomitant conditions impairing adrenal function. I've seen some relatively serious cases caused by the above three alone. Also, I haven't seen one case of this that didn't show some degree of hypothyroidism aswell.—The preceding unsigned comment was added by 81.108.30.175 (talk • contribs).

What on Earth does "emotional malnutrition" mean? Anything at all? I know what stress is, and if it can cause this condition, I would support including it, but I suspect "emotional malnutrition" is meaningless crap. It sounds like something out of some hippie self-help book, and not medical at all. If this is a real medical term, however, please clarify. Emily

My sister was diagnosed with addison's 30 years ago when she was three, I was the only family member who knew how to keep her well until she was 13 then my step-mom was in control until she was 17. She is now married with 2 tween kids. Her husband and kids have are not involvd in her care as intimitatly as I was, and because of this she will go off her meds and end up in the hospital with hypoglacimia and irregular heart beat. My problem is how do I get her to take responsobility for her disease so her family doesn't have to watch her die. It's has if she doesn't care and no one has the right to try to talk to her about it. Desperate to save my sisterDamhd (talk) 16:30, 18 March 2009 (UTC)

I'm sorry to hear that your sister has health problems. Unfortunately, we can't really help you. This page is for discussing improvements to the article. You should consider contacting your sister's physician. They will probably not be able to tell you anything about her, but they can listen to what you have to say. WhatamIdoing (talk) 05:17, 23 March 2009 (UTC)

A couple of Addison-like images

File:A 69-Year-Old Female with Tiredness and a Persistent Tan 01.png and File:A 69-Year-Old Female with Tiredness and a Persistent Tan 02.png -- but I'm not sure whether it is Addison's or SIADH. Have not read the article thoroughly. Use at your discretion. --CopperKettle 05:50, 25 October 2009 (UTC)

Comment RE: Vitiligo

Stated in the Wiki article on Vitiligo is the following: "Addison's disease (typically an autoimmune destruction of the adrenal glands) may cause vitiligo.[7][8]". Here in this article stated is the following: "Adrenal insufficiency is manifested in the skin primarily by hyperpigmentation.[5]:501". This is a careless statement and needs to be contended because if you continue to read the Wiki article on Addison's disease, stated ALSO is the following: "Signs of conditions that often occur together with Addison's: goitre and vitiligo". It is claimed that Addison's disease is a rare endocrine disorder wherein the adrenal glands produce insufficient(ly). So which is it? It can't cause Vitiligo AND hyperpigmentation as claimed in this article. —Preceding unsigned comment added by 38.99.11.219 (talk) 00:28, 19 December 2009 (UTC)

You're right - the wording is sloppy. It would be more accurate to say that Addison's is associated with vitiligo but actually causes hyperpigmentation. In other words, people with Addison's may have vitiligo in much the same way as they may also have thyroid problems, i.e. as an association. On the other hand, as described in the article, Addison's causes hyperpigmentation by virtue of the high levels of ACTH, and thence MSH, found in the condition. Gaussgauss (talk) 09:35, 25 July 2010 (UTC)

Addisonian crisis

A while ago I looked for good sources to improve the content about Addisionian crisis. PMID 17127145 seems to be the best. PMID 18496365 is about adrenal insufficiency in critically ill patients. JFW | T@lk 21:24, 17 August 2010 (UTC)

Adrenal insuficiency should also be included! It's nearly the same.

http://en.wikipedia.org/wiki/Adrenal_insufficiency —Preceding unsigned comment added by 83.221.75.4 (talk) 07:37, 10 September 2010 (UTC)

Proposed merge

I oppose the proposed merge. The lay press often assumes that Addison's=autoimmune, and I agree that in Western societies, this is believed to be the most common cause. However, historically, the most common cause has been tuberculosis, and this cause is again on the rise. No content was removed from Addison's disease to seed autoimmune adrenalitis, so the proposed merge is simply a proposal to eliminate autoimmune adrenalitis. The phrase "autoimmune adrenalitis" shows up in 626 books, so the phrase is idiomatic, and the distinction is germaine. Merger would be metonymy. --Arcadian (talk) 18:40, 29 March 2009 (UTC)

I believe that the idea behind the merge is not that Addison's=autoimmune, but rather, since autoimmune adrenalitis is a cause of Addison's disease might it be better to describe it within the Addison's page, rather than having a short separate stub page. (I am not aware of a type of autoimmune adrenalitis that does not cause Addison's - is there an example of an adrenal medulla-specific autoimmune process?) Having said that, a full discussion of autoimmune adrenalitis especially the genetics would probably overwhelm the main Addison's page so I also oppose the merge, in the hope of an expansion of the autoimmune adrenalitis page .Celefin (talk) 15:16, 10 April 2009 (UTC)

I agree that Autoimmune adrenalitis is a different diagnosis than is Addisons, whereas Addisons is limited to the Zona Glomerulosa, AA targets all three layers of the cortex. Additionally, several symptoms are present in AA that are not seen in Addisons, thus a ddx is needed. Rrten00 (talk) 16:06, 29 April 2011 (UTC)

Updating

Using the Ten & AdrenalCrisis sources I think I could give this article a reasonable backbone. I am trying to avoid discussions of nomenclature, but I am starting to wonder if we shouldn't rename this page to "adrenal insufficiency", with explanations that Addison's is reserved for primary hypoadrenalism (autoimmune, mycobacterial etc). I will also need to dig into the textbooks, because there are not many good review articles on this. JFW | T@lk 20:26, 23 October 2011 (UTC)

MC COD

what is the most common cause of death WITHOUT Treatment. I know it is during a time of an acute stress - surgery, illness, but what is it? CV Failure,? coma? ??? 76.174.42.22 (talk) 03:01, 21 July 2008 (UTC)

Addison's is rare, so this may not have been studied in sufficient detail. Try the reference desk. JFW | T@lk 17:11, 22 July 2008 (UTC)

believe its CV failureBYS2 (talk) 09:56, 3 November 2011 (UTC)

Addison's Disease cannot be Secondary

The introduction section seems to imply that Addison's Disease can be from problems in the adrenal, pituitary or hypothalamus. This is incorrect, by definiton, Addison's disease is chronic primary adrenal insufficiency. There is no such thing as "secondary Addisson's Disease". One of the defining features of Addison's is hyperpigmentation which does not occur in secondary adrenal insufficiency. Therefore I have removed that section BYS2 (talk) 03:20, 2 November 2011 (UTC)

Not really. There are numerous sources that refer to the concept. Furthermore, "addisonian crisis" can occur in secondary adrenal insufficiency. It would be more helpful to add a few words explaining that the term "Addison's disease" is usually reserved for primary hypoadrenalism. Ideally this should be supported with a source. JFW | T@lk 07:17, 2 November 2011 (UTC)

acutally that's incorrect, no source (except the current Wikipedia article) state that Addison's disease can be used for anything but primary adrenocortical insuffiency. for example:

Robbin and Cotran - Pathologic Basis of Disease 8th edition (page 1155) states:

"Addison disease, or chronic adrenocortical insufficiency, is an uncommon disorder resulting from progressive destruction of the adrenal cortex" - listed under "primary chronic adrenocortical insufficiency"

CURRENT Diagnosis & Treatment: Emergency Medicine, 6e states:

"Primary adrenocortical insufficiency (Addison's disease) results from primary destruction or inhibition of the adrenal glands. There are several known causes such as autoimmune insults (most common), infection (tuberculosis most common world wide while AIDS is most common in the United States), systemic inflammatory response, hemorrhage, metastatic carcinoma, and medications."

Guyton and Hall - Textbook of Medical Physiology states:

"Addison's disease results from an inability of the adrenal cortices to produce sufficient adrenocortical hormones ... Secondary adrenal insufficiency is much more common than Addison's disease, which is sometimes called primary adrenal insufficiency. "

The Merck manual (http://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/adrenal_disorders/addisons_disease.html) states:

"Addison's disease is an insidious, usually progressive hypofunctioning of the adrenal cortex. It causes various symptoms, including hypotension and hyperpigmentation, and can lead to adrenal crisis with cardiovascular collapse."

http://emedicine.medscape.com/article/116467-overview#showall states that:

Addison disease (or Addison's disease) is adrenocortical insufficiency due to the destruction or dysfunction of the entire adrenal cortex. - clearly this is primary adrenal insufficiency

and finally, the national health institute (http://www.nlm.nih.gov/medlineplus/ency/article/000378.htm):

"Addison's disease results from damage to the adrenal cortex. The damage causes the cortex to produce less of its hormones.m"

I could find you dozens of textbooks and all would say that Addison's disease is primary adrenocortical insufficiency.

While the term "Addisonian crisis" is sometimes used to refer to secondary adrenal insufficiency, this is another issue and not related to the naming of Addison's disease.

BYS2 (talk) 04:12, 3 November 2011 (UTC)

Fine. I see what you mean and I agree with the current version of the introduction. I have modified it slightly, and added the point that Addisonian crisis can occur in any form of hypoadrenalism. JFW | T@lk 20:45, 7 November 2011 (UTC)

Improper Use of possesive eponyms

Please remember that we no longer refer to eponymous patholodies in the possessive, thusly, I propose an article title change. 96.230.193.176 (talk) 04:04, 6 March 2010 (UTC)

Do we? Where is your source for this? JFW | T@lk 21:24, 17 August 2010 (UTC)

A quick note on the "Vitaligo" statement.. I myself caught myself becoming confused by the "hyperpigmentation" while at the same time seeing "vitaligo" as a sign and symptom.. Due to personal experience I can say that vitaligo in Addisons patients usually means there is an underlying medical condition, such as hyperthyroidism. I myself was diagnosed with Multiple Sclerosis (auto immune) and last year had 2 diagnosis added to that. One being Hyperthyroidism, the second being Addisons disease.. When I asked my physician, I was told the vitaligo was cause by the hyperthyroidism, not Addisons Disease.. —Preceding unsigned comment added by 24.255.142.237 (talk) 00:56, 13 February 2011 (UTC)

The usage of non-possesive naming is now the accepted norm http://en.wikipedia.org/wiki/List_of_eponymously_named_diseases and agree with changing the name and usage to Addison Disease. This is how this ailment is being described in medical textbooks and in medical CME courses. — Preceding unsigned comment added by 184.155.87.251 (talk) 02:20, 28 February 2013 (UTC)

Adding a journal reference for this new standard naming convention ^ "Classification and nomenclature of morphological defects". Lancet 1 (7905): 513. March 1975. doi:10.1016/S0140-6736(75)92847-0. PMID 46972. — Preceding unsigned comment added by 184.155.87.251 (talk) 02:22, 28 February 2013 (UTC)

withdrawal of long term steroids

"Adrenal Crisis" redirects to this page. An adrenal crisis may be caused by withdrawal of steroids in long term steroid patients. If the redirection stands, should this be covered here? doesn't seem to be mentioned. On the other hand, it's not by definition Addison's. Maybe the redirection should be reversed and a separate page created for Adrenal Crisis? Any thoughts? — Preceding unsigned comment added by 128.240.229.65 (talk)

Yes, I would also want "An adrenal crisis may be caused by withdrawal of steroids in long term steroid patients" information added for adrenal crisis. It is not an assumption but my personal experience. It would be quite helpful. --Nancyinthehouse (talk) 05:49, 3 April 2013 (UTC)

Death by Addison?

Can you actually die from Addison's? StarLegacy (talk) 17:02, 7 November 2010 (UTC)

Were you prompted to ask this question because of the addition of Fritz Schlemmer who is supposed to have died of Addison's? My source says that's what he died from, but details are scarce. Maybe his body was so weakened that he died from something else that would normally not have been fatal. How advanced was knowledge of Addisons in 1947? —Preceding unsigned comment added by Kashikom (talk • contribs) 21:16, 18 November 2010 (UTC)

Anything that provokes a coma could cause death, I suppose, if not treated. The article on Elizabeth Catez ("Elizabeth of the Trinity") says she died of it. I would like to know when people stopped dying of it, i.e. when did treatment become known and readily available? --Richardson mcphillips (talk) 14:40, 8 November 2012 (UTC)

Death where Addisons disease has has been diagnosed is very rare however there are deaths caused by adrenal crisis where addisons disease is diagnosed post mortem. Flatoitlikealizarddrinking (talk) 14:10, 20 April 2013 (UTC)

Acanthosis nigricans incorrect!

The picture and caption of acanthosis nigricans should be removed. A common feature of Addison's disease is hyperpigmentation, due to elevated MSH levels, which is correctly stated in the Clinical Signs/Signs and Sypmtoms section. Acanthosis Nigricans is a different skin finding, often related to insulin overproduction. StevenRoyKnight (talk) —Preceding undated comment added 21:42, 28 April 2013 (UTC)

• Agree. There are a number of causes of acanthosis nigricans, with the most common being insulin resistance, and the condition includes both thickening of the skin AND hyperpigmentation. Acanthosis nigricans can be caused by hormonal changes associated with the adrenal gland, however the hyperpigmentation that is a common presenting sign of Addison's disease is not a synonym for acanthosis nigricans. Acanthosis nigricans is usually found in only the body folds, whereas classic hyperpigmentation of Addison's disease is found in the creases of the palm of the hand,[4] buccal mucosa [5], and around scars.[6] I suggest a change of image that denotes classic Addisonian hyperpigmentation. FlatOut 00:39, 29 April 2013 (UTC)

4philip.org

This link has now been added more than once, and the anonymous editor who added it has been in contact with Jeff G. (talk · contribs) about it. I agree with Jeff G. that the link is unsuitable. Not every disease charity should be linked from this page, only nationwide and widely recognised organisations. This organisation seems to be centered in North Carolina and Duke's.

I would expect a charity with high profile to have accurate information on its website. Here's a quote from the front page:

“ Did you know?
ALL cancers are forms of autoimmune disease?
Addison’s Disease and adrenal insufficiency are also forms of autoimmune disease? ”

There's two glaring errors in this statement alone. Cancer is not conventially regarded as an autoimmune disease, and there are plenty of forms of adrenal insufficiency that are not immune-mediated. JFW | T@lk 11:52, 31 March 2013 (UTC)

• Support.   — Jeff G. ツ (talk) 00:47, 6 April 2013 (UTC)
• Yes not a suitable link. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:26, 20 April 2013 (UTC)

My name is Eric Hart, the anonymous editor in question. I am now registered on Wikipedia and I am the founder and CEO of 4Philip dot Org. We are recognized by the IRS as a 501c3 charity and are also recognized by NADF and the Addison's support groups and have started locally in North Carolina as that is where we are based. Our mission is to extend our reach internationally as we grow. With regards to your comment about cancers, you are free to contact Dr. Michael Freemark at Duke University as this is a direct quote from him. Duke's research is above reproach and I challenge anyone on this site to prove otherwise. You can reach to me directly from the contact page of 4philip.org as my direct office number is listed there. Regards, Eric Hart Ericwhart (talk) 03:31, 3 May 2013 (UTC)

Welcome Eric. If you make an edit you are responsible for citing a reliable source. Re: linking your charity, see WP:MEDMOS and specifically the section on avoiding links to local, state, or regional charities. You might also find this helpful WP:PSCOI Cheers FlatOut 04:31, 3 May 2013 (UTC)

Flatout The issue in question is posting a link to 4philip.org Since other organizations who have similar missions are posted there, the matter is of the constant removal of 4Philip.org

I fail to see the rationale behind removing the link as 4Philip is united in a common cause, that of eliminating Addison's disease. Ericwhart (talk) 06:08, 3 May 2013 (UTC)

The rationale is that local, state and regional charities do not meet the Wikipedia standard WP:MEDMOS. The other EL's are national FlatOut 06:17, 3 May 2013 (UTC)

Then by that standard NADF does not qualify as there is a donation option on their main page. See item number 5 under external links. Ericwhart (talk) 11:06, 3 May 2013 (UTC)

That may be the case although it is a national organisation and there is some discretion allowed for charities relating to rare diseases (see paragraph after point 5). Whatever the status of that organisation it doesn't change the fact that 4Philip.org is not a suitable link. I have also provided you with links to the wp standard on conflict of interest that you should read. FlatOut 11:27, 3 May 2013 (UTC)

Addison's disease - yikes, that photo!

When one searches Addison's disease on Facebook, one is directed to a FB managed page of Wikipedia page of Addison's disease. With a dreadful open-mouth photo. If one "likes" the page -- one like me, who has Addison's disease -- that ridiculous and ugly photo stands out on one's own FB page, listing one's "likes." I see no educational value in this awful photo. Please, please replace it with something more meaningful, or please just remove it! We have enough controversy in the Addisonian family, and especially among our families! Thanks so much! — Preceding unsigned comment added by KarenJohnsonKJPR (talk • contribs) 00:52, 14 December 2013 (UTC)

There is nothing wrong with this article: I wish to stress that it is a FB problem and therefore you should blame FB for it. Nevertheless I harmlessly swapped the two images in order to get as first image something less colourful. -- Basilicofresco (msg) 18:12, 19 December 2013 (UTC)

How about adding a picture of an Adrenal gland to the top of the page? The caption for the picture could be something like, "In classic Addison's disease, the adrenal gland is deficient due to autoimmune destruction". — Preceding unsigned comment added by Bakerstmd (talk • contribs) 19:04, 29 April 2014 (UTC)

Basilicofresco is right in the reply above. Please think more carefully about what you are saying above. You are confusing "the photo has no educational value" (which is obviously false) with "I wish the photo didn't pop up prominently in my Facebook feed". The latter is a perfectly understandable wish, but it has nothing to do with the educational value of the photo in an encyclopedia article on the disease. Which you will probably understand if you think more carefully about it for a moment. As far as a valid solution (versus the invalid one of deleting the photo), the other users who replied have the right idea—make the first image on the page something less eye-catching. Facebook will eventually then display that image instead of the clinical photo. But if it doesn't, that will be a Facebook problem, not a Wikipedia problem. Quercus solaris (talk) 16:49, 30 April 2014 (UTC)

Lancet

Review on adrenal insufficiency: doi:10.1016/S0140-6736(13)61684-0 JFW | T@lk 19:54, 23 June 2014 (UTC)

JCEM

Central hypoadrenalism review doi: 10.1210/jc.2014-2476 JFW | T@lk 22:34, 24 August 2014 (UTC)

Current structure of 'causes'

I quote: Impaired steroidogenesis[edit]To form cortisol, the adrenal gland requires cholesterol, which is then converted biochemically into steroid hormones. Interruptions in the delivery of cholesterol include Smith-Lemli-Opitz syndrome and abetalipoproteinemia.

Of the synthesis problems, congenital adrenal hyperplasia is the most common (in various forms: 21-hydroxylase, 17α-hydroxylase, 11β-hydroxylase and 3β-hydroxysteroid dehydrogenase), lipoid CAH due to deficiency of StAR and mitochondrial DNA mutations.[1] Some medications interfere with steroid synthesis enzymes (e.g. ketoconazole), while others accelerate the normal breakdown of hormones by the liver (e.g. rifampicin, phenytoin).[1]

However Synthesis fails with pituitary destruction (tumor, sheehans syndrome ...) ANd Acceleration of steroid metabloism by the liver is not failure of steroidogenesis — Preceding unsigned comment added by Sea7Spray (talk • contribs) 13:05, 30 December 2014 (UTC)

Palmar creases

>as well as darkening of the palmar creases....

I think more a specific wording should be used here to indicate where on the palm the discoloration is found. Rissa, copy editor (talk) 07:47, 11 January 2015 (UTC)

Possible inclusion on page for section 'Differential diagnoses'

Possible relations of Addison's Disease to Chronic Fatigue Syndrome/Myalgic Encephomylitis

It has been proposed by some specialists that Chronic Fatigue Syndrome is a form of Addison's disease (referred to as adrenal insufficiency or hypoadrenalism). The following evidence has been presented 'In view of the 36 features shared by Chronic Fatigue Syndrome and Addison’s disease, including hypocortisolism and a host of neuropsychological complaints and investigations of the effects after supplementation with mineralocorticoids (fludrocortisone), low-dose hydrocortisone (cortisol) in the treatment of CFS’.

http://en.wikipedia.org/wiki/Chronic_fatigue_syndrome#Differential_diagnoses

This is clearly a minority view, and the fatigue of hypoadrenalism is not comparable to that of CFS. Subtle disruption of the HPA axis in CFS is not the same as over hypoadrenalism as seen in Addison's. JFW | T@lk 10:03, 29 March 2011 (UTC)

Agree that CFS should not be mentioned BakerStMD T|C 01:44, 21 January 2015 (UTC)

Osama bin Laden

>Osama bin Laden may have had Addison's. Lawrence Wright noted that bin Laden exhibited the key symptoms of Addison's, including "low blood pressure, weight loss, muscle fatigue, stomach irritability, sharp back pains, dehydration, and an abnormal craving for salt". Bin Laden was also known to have consumed large amounts of sulbutiamine to treat his symptoms.

Was known to have consumed large amounts of sulbutiamine by whom? And how do we know he was taking this drug "to treat his symptoms"? Lawrence Wright isn't a physician and he wasn't treating bin Laden. This sentence either needs a specific reference to his doctor or his medical records, or it should be deleted. Rissa, copy editor (talk) 07:19, 11 January 2015 (UTC)

• Agree Would favor requiring a high standard of evidence before perpetuating that statement about bin Laden. BakerStMD T|C 03:44, 21 January 2015 (UTC)

Clinical signs

>On physical examination, the following may be noticed: 1) Low blood pressure that falls further when standing (orthostatic hypotension); 2) Most people with primary Addison's have darkening (hyperpigmentation) of the skin....; 3) Medical conditions, such as type I diabetes, thyroid disease (Hashimoto's....

The first one has just the physical description, "low blood pressure that falls further..." However, the next two are little descriptive paragraphs. All three should have the same structure which can most easily be accomplished by a bit of editing:

1) Low blood pressure etc; 2) Darkening of the skin etc; 3) Diseases such as Type 1 Diabetes, thyroid disease etc

I can do this or someone more attached to the entry can. Rissa, copy editor (talk) 06:08, 11 January 2015 (UTC)

That list is a mess from a medical perspective, too. "Clinical Signs" (or just Signs) are found only on physical exam because they are not obvious to the patient, while "Symptoms" are things the patient notices and reports. Blood pressure is neither, it's a vital sign. Type 1 diabetes and thyroid are past medical history. But I digress. I should just fix it. BakerStMD T|C 03:47, 21 January 2015 (UTC)

Post steroids

doi:10.1210/jc.2015-1218 JFW | T@lk 14:25, 8 June 2015 (UTC)

Hyperpigmentation image

I know the image in the lead has sparked controversy before, but I'd like to question its medical value. Where, precisely, is the hyperpigmentation? I don't see it. The best image would be one with a before- and after-addison's, showing the same anatomic feature, pre- and post-pigmentation. Without that, i think the image in the lead adds little. BakerStMD 02:31, 29 July 2015 (UTC)

Thomas Addison

Why does the introduction section of the article mention Addison's alma mater? Is it relevant? — Preceding unsigned comment added by Samern92 (talk • contribs) 16:45, 26 October 2015 (UTC)

ACTH stimulation test

... at both low and high doses is effective in diagnosing but not in ruling out of hypoadrenalism. doi:10.1210/jc.2015-1700 JFW | T@lk 15:37, 14 December 2015 (UTC)

Guideline

... on diagnosis and treatment doi:10.1210/jc.2015-1710 JFW | T@lk 15:40, 18 January 2016 (UTC)

notable cases

Per WP:MEDMOS we generally don't do this, unless there are sources that describe how the person's having the disease affected the history of the disease.

Notable cases

United States president John F. Kennedy (1917–1963), probably the most famous case of Addison's disease

• John F. Kennedy, the 35th President of the United States, was one of the best-known people with Addison's disease and was possibly one of the first to survive major surgery. Substantial secrecy surrounded his health during his years as president.
• Eunice Kennedy Shriver, one of John F. Kennedy's sisters, was believed to have Addison's disease as well.
• Popular singer Helen Reddy.
• Scientist Eugene Merle Shoemaker, co-discoverer of the Comet Shoemaker-Levy 9.
• French Carmelite nun and religious writer Saint Elizabeth of the Trinity
• American artist Ferdinand Louis Schlemmer died from Addison's disease.
• Some have suggested Jane Austen might have had the condition before it was named (avant la lettre) but others have disputed this.
• According to Carl Abbott, a Canadian medical researcher, Charles Dickens may also have been affected.
• Australia's youngest rugby league football international, Geoff Starling
• Osama bin Laden may have had Addison's. Lawrence Wright noted that bin Laden exhibited the key symptoms of Addison's, including "low blood pressure, weight loss, muscle fatigue, stomach irritability, sharp back pains, dehydration, and an abnormal craving for salt". Bin Laden was also known to have consumed large amounts of sulbutiamine to treat his symptoms.
• Basque nationalist and founder of the Basque Nationalist Party, Sabino Arana died in Sukarrieta at the age of 38 after falling ill with Addison's disease during time spent in prison.
• A cappella singer/arranger/producer Deke Sharon
• One of Canada's top gymnasts, Nathan Gafuik, was diagnosed with Addison's disease when he was 15.
• Former South Korean President Park Geun-hye is reported to have Addison's disease.

References

-- Jytdog (talk) 00:16, 24 July 2017 (UTC)

https://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style/Medicine-related_articles#Society_and_culture

" WP:MEDTRIVIA

See also: Wikipedia:Biographies of living persons, Wikipedia:Trivia sections, and Wikipedia:Lists (stand-alone lists) § Lists of people Articles on medical conditions sometimes include lists of notable individuals who have (or had) the disease. This may be manageable if the disease is rare. For common conditions, it can become a distraction from the main article and contain much unreferenced and dubious material. If you do include such a list, ensure your entry criteria are well defined so that future editors may know if their additions are welcome. One restriction that some editors favour is to include only those individuals who have lastingly affected the popular perception of a condition, such as through public awareness campaigns or enduring media coverage.

Judging by what the WP MOS actually says, it seems to include common lists of notable individuals who may have had the disease.

I suppose however citing the WP MOS is probably some obscure violation of WP rules in some other manner and irrelevant to an editor determined to maintain the article in the manner they prefer. --108.31.125.50 (talk) 22:13, 8 September 2018 (UTC)

Suggested Improvements (2019)

The following discussion is an archived discussion . Please do not modify it. Subsequent comments should be made in a new section on the talk page. No further edits should be made to this section.

All Completed | 1. Remove File:Addisons hyperpigmentation.jpg from the article template and replace it with File:Addison'sLegs.jpg. (completed) 2. Remove the adjective "classic" from the article template image caption as it may be offensive to people with the illness.' (completed) 3. Remove the line "The adjective "addisonian" is used to describe features of the condition, as well as people with Addison's disease" from the article because there is no reference supporting this. not needed 4. Remove vomiting from the illness symptoms because this is not referenced, either. not needed 5. The information about the discovery of the illness should be cleaned up, because it does not compile with Wikipedia:GRAMMAR (completed) | Dino245 (talk) 22:51, 2 October 2019 (UTC)

1) Not sure why the fact that the person was white was removed?

2) Not sure why the darkening of the gums was moved completely? Doc James (talk · contribs · email) 23:42, 6 October 2019 (UTC)

3) Because it is ugly, not descriptive and not good image quality. Now please stop edit warring or there will be trouble. Dino245 (talk) 18:55, 7 October 2019 (UTC)

User:Dino245 "Ugly" is not a criteria for removal. We are not censored. I do not think it is unreasonable to remove it from the lead, but it still has a place in the article IMO.

As the image has been in this article a long time, YOU will need consensus to remove it. Doc James (talk · contribs · email) 18:57, 7 October 2019 (UTC)

User:Doc James OK, Lets keep the image, but can we please delete the adjective "classic" from the image caption as this may be offensive to people with the illness. Dino245 (talk) 19:16, 7 October 2019 (UTC)

User:Doc James Can you please also review the other suggested improvements? Thanks, Dino245 (talk) 19:18, 7 October 2019 (UTC)

Sure your edit here is fine[7]

Per "Remove the line "The adjective "addisonian" is used to describe features of the condition, as well as people with Addison's disease" from the article because there is no reference supporting this." a reference is provided?

Vomiting has a reference to support it. Doc James (talk · contribs · email) 19:27, 7 October 2019 (UTC)

How do you want to adjust the history section? Doc James (talk · contribs · email) 19:30, 7 October 2019 (UTC)

User:Doc James Clean Up the section per WP:GRAMMAR. Dino245 (talk) 23:40, 7 October 2019 (UTC)

User:Doc James Okay, suggested improvements is closed. I will be doing a Good article assessment on the page. — Preceding unsigned comment added by Dino245 (talk • contribs) 18:19, 8 October 2019 (UTC)

Hi I am a 60 year old male with Addison’s disease do I need to self isolate because of Coronavirus? — Preceding unsigned comment added by 2A02:C7D:1A5A:5D00:8D25:70FD:3458:D8F2 (talk) 22:57, 22 March 2020 (UTC)

from President Kennedy talk page

Addissn's disease and a suntan advertisement

Healio.com has this regarding Addison's disease: "Ironically, then, President Kennedy’s famous suntan was the sign not of a fit and outdoorsy man, but of something much darker and more dangerous."

An advertisement from back then said "be the man with the Florida tan", and this has me wondering how much of an inspiration JFK was for this. He was president in 1961-1963, ceasing abruptly by assassination. Carlm0404 (talk) 07:06, 25 November 2020 (UTC)

I just explained on Kennedy talk page that the "Florida tan" inspiration, if from Kennedy, would have been from Kennedy's "tan". I can't move that idea beyond talk pages because of insufficient information. Kennedy's Addison's disease would not have been publicly known then. Carlm0404 (talk) 23:24, 25 November 2020 (UTC)

A Commons file used on this page or its Wikidata item has been nominated for deletion

The following Wikimedia Commons file used on this page or its Wikidata item has been nominated for deletion:

• Addisons hyperpigmentation.jpg

Participate in the deletion discussion at the nomination page. —Community Tech bot (talk) 07:53, 25 July 2021 (UTC)