[Addison's disease: looking to the past and the future]

Area of Science:

• Endocrinology
• Immunology
• Medical History

Background:

• Addison's disease was first described in 1849, linked to adrenal gland alterations.
• Bilateral adrenalectomy was found to be fatal in animal studies.
• Nobel Prize-winning discoveries in 1950 elucidated adrenal cortex hormones, their structure, and effects.

Purpose of the Study:

• To review the historical context and evolving understanding of Addison's disease.
• To highlight current causes, including autoimmune, genetic, and iatrogenic factors.
• To emphasize the importance of patient education and multidisciplinary management.

Main Methods:

• Historical review of key discoveries and research milestones.
• Analysis of current etiological factors and their prevalence.
• Discussion of contemporary management strategies and ongoing research.

Main Results:

• Autoimmune adrenalitis is the predominant cause (nearly 80%) of diagnosed Addison's disease.
• Genetic and iatrogenic causes, particularly from cancer immunotherapies, are increasingly recognized.
• Addison's disease significantly increases mortality risk.

Conclusions:

• Effective management of Addison's disease requires comprehensive patient education on triggers like stress and infection.
• Multidisciplinary care involving endocrinologists, general practitioners, and critical care specialists is essential.
• Ongoing research focuses on optimizing therapies, including hydrocortisone, mineralocorticoids, and adrenal androgens.