La maladie d’Addison; un regard tourné vers le passé et vers l’avenir

In 1849, Thomas Addison discovered alterations
in the adrenal glands at autopsy of three patients who had
died with idiopathic anemia. Struck by Addison’s work,
Charles-Edouard Brown-Séquard demonstrated in 1851
that bilateral adrenalectomy in dogs was fatal. It was not
until 1950 that the discovery of the hormones of the adrenal
cortex, their structure and their biological effects allowed
Kendall, Reichstein and Hench to win the Nobel Prize in
Physiology or Medicine. Nowadays, autoimmune adre nalitis accounts for almost 80 % of cases diagnosed with
Addison’s disease. The causes of this serious condition,
which doubles the mortality rate of affected patients com pared to the general population, have been expanded by
genetic and iatrogenic causes. The latter are increasin gly associated with immunological cancer therapies. It is
essential to educate the patients with Addison’s disease to
improve the management of their condition and to remain
responsive to the many triggers such as stress, infections
or surgery. The management of Addison’s disease is of
interest not only to endocrinologists but also to general
medical and critical care practitioners. Recent studies aim
to improve the understanding of the physiological and the rapeutic effects of hydrocortisone, mineralocorticoids and
adrenal androgens.x