Q: I was diagnosed with Addison’s disease in 1992 and kept very well until mid ’97 when I started getting agonising pains in my right calf. Just prior to this I also had palpitations and terribly severe pins and needles in both legs.  I have been prescribed pain killers and various anti-inflammatory drugs, but nothing has helped. The hospital do not think my pain is caused by Addison’s disease and are currently running tests for sciatica. I take 300mg hydrocortisone daily, I go twice a year for a check up where my blood pressure  is taken plus a blood test.

I was told when starting treatment for Addison’s disease that my aldosterone level was low and that I may have to be on that, but I never been given it and wonder if that may have anything to do with my problems.

A: It is difficult to decide, without seeing the patient, whether the leg pains in the calf in Addison’s disease is due to muscle spasm which could be due to disturbances of sodium and potassium in the blood or whether it is due to a problem with the blood supply to the leg or indeed something like the referred pain of sciatica. A great majority of patients who have destruction of the adrenal gland itself (true Addison’s disease) rather than pituitary deficiency leading to hydrocortisone deficiency, will need a replacement for the aldosterone.  If the lack of hydrocortisone is due to pituitary disease then this is not normal to require aldosterone to be replaced. The commonest cause of disease of the adrenal gland istelf, other than past steroid therapy, is autoimmune destruction of the adrenal gland, aldosterone may not be deficient intitially but usually becomes so fairly rapidly. Aldosterone replacement is given with the compound fludrocortisone the trade mark if which is Florinef.

It is usual to monitor the requirement for fludrocortisone by measuring the patient’s circulating renin levels about two hours after taking the morning dose of hydrocortisone while the patient is lying flat. Circulating renin levels are elevated when patients require fludrocortisone despite being adequately replaced with hydrocortisone. The patient should check with her endocrinologist and should point out that she was told at diagnosis in 1992 that she would eventually require fludrocortisone and ask whether this has been checked for.