Conditions such as type 1 diabetes, coeliac disease, hypothyroidism and Addison’s disease are autoimmune conditions. Being diagnosed with one may increase the risk of developing another.

Meet Val

Val has lived with type 1 diabetes for 60 years and, for most of this time, Addison’s disease as well.

What does this mean?

The combination of Addison’s disease, sometimes called adrenal insufficiency, and type 1 diabetes is known as Schmidt syndrome. Although less than 1% of the population with type 1 diabetes has Addison’s disease, the risk of being diagnosed with it is significantly higher in those with type 1 diabetes than those without. Commonly, it occurs around 30-50 years old, but can occur at any age, ethnicity or gender.

What is Addison’s disease?

Two of the most important hormones made by the adrenal glands, which are located just above each kidney, are cortisol and aldosterone. Cortisol has multiple functions including creating the response to stress, helping to maintain blood pressure and cardiovascular function, slowing the immune system’s inflammatory response, raising blood glucose levels in response to stress or fasting, regulating the metabolism of proteins, carbohydrates and fats, and maintaining proper arousal and sense of wellbeing. The amount of cortisol in the body is precisely regulated by the pituitary gland and a region of the brain called the hypothalamus. Aldosterone, is a hormone that helps the kidneys retain sodium (salt) and excrete potassium, which in turn helps maintain blood pressure.

Addison’s disease occurs when your adrenal glands do not produce enough of the hormone cortisol and often aldosterone. These hormones are very important, and their jobs include controlling blood glucose levels, regulating metabolism, growing tissue, regulating mood, responding to stress, and helping you form memories.

What are the signs?

• Muscle weakness or pain
• Hyperpigmentation of skin
• Fatigue
• Mood irregularity
• Salt cravings
• Weight loss and loss of appetite
• Low blood pressure
• Nausea and/or diarrhoea
• Abdominal pain
• Lower back and/or leg pain

Other symptoms consistent with adrenal insufficiency include dizziness, anorexia, weakness, nausea and vomiting.

The effect on type 1 diabetes

Hypoglycaemia is the most common acute complication in patients with type 1 diabetes. In Val’s case, she was diagnosed with Addison’s disease following a period of severe hypoglycaemia and intermittent, severe fatigue. Her doctor at first thought the hypos were due to too much insulin and reduced her dose. However the hypos continued and often took a long time for her blood glucose level to return to her target range. She also started to lose weight and her blood pressure dropped.

Getting diagnosed

In order to diagnose Addison’s disease, your doctor will want to know about your medical history and any symptoms you may be experiencing. They may also order lab tests for you. A blood test will measure your hormone and mineral levels, and a CT scan or MRI will look at the size of your adrenal glands.

How is it treated?

Addison’s disease can have a huge impact on health and wellbeing. However, it can be treated through daily prescription hormones that come in tablet form and replace the missing hormone. Women may also be prescribed other medication, which can help mood and sex drive. If your adrenal hormone levels become dangerously low, immediate medical care will be needed.

Final words from Val

“I have managed to have three children along the way. It was a challenge when I was young and when I was pregnant. The hypos were the worse. Once I started on treatment though everything improved. I am careful to take my medication, and if I get stressed or sick, my doctor gave me a plan of how to increase my medication. Touch wood I haven’t had too many problems, my last HbA1c was 6.8 and I don’t have any complications.”

Written by Angela Blair