As researchers in the field of Addison’s disease, we are continually striving to identify patients with Addison’s disease promptly, so that it can be treated immediately. Untreated Addison’s disease can be fatal. Autoimmunity (a cellular reaction where the body attacks itself) is the most common cause of Addison’s disease in the Western world.
In the developing world, tuberculosis of the adrenal glands can on occasion produce Addison’s disease. For physicians, it may be a challenge to distinguish some of the symptoms and signs, which occur in tuberculosis from those of Addison’s disease, with the result that the diagnosis of Addison’s disease could be missed in this group of patients. For example, some of the symptoms that patients with tuberculosis may have, may also occur in Addison’s disease including; profound weight loss, poor energy levels, diarrhoea and salt imbalance in the blood.
It is widely known that human immunodeficiency virus (HIV) impairs the immune response, resulting in several serious infections, such as tuberculosis fungal infections and several malignancies, many of which are treatable, especially with modern anti-infectious agents and anti-viral agents used in the management of Acquired Immune Deficiency Syndrome (AIDS). Several case reports have indicated that among HIV-positive patients, Addison’s disease has occurred. The prevalence of HIV positive patients in South Africa is as high as 29% of the population. A smaller proportion of these people have AIDS and are at-risk of the multiple infections that can occur, which are known potentially to involve the adrenal glands.
In this study, we will be screening patients with advanced AIDS for Addison’s disease, when they are admitted to hospital for one of these known serious infections. We will be taking blood for appropriate chemistry, in order to help us make the diagnosis of Addison’s disease in these patients. It has not been the routine practice to screen patients with advanced AIDS for Addison’s disease, but it is possible that these patients may also have Addison’s disease. Conceivably if they are treated appropriately for Addison’s disease, they may have an improved prognosis. Once we have identified the patients with Addison’s disease and treated them appropriately, we will be asking which of the symptoms and signs predict Addison’s disease in this population, so that we will easily identify future patients, who are at risk for Addison’s disease.
Dr Ian Ross