She Craved Salt and Felt Nauseated for Months. What Was Unsuitable?

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She Craved Salt and Felt Nauseated for Months. What Was Wrong?

The doctor greeted them warmly. Then he said more sternly, “It looks like you have a tan. Have you been out in the sun “It wasn't the first time she'd heard this.“ My friends keep saying that! ”She exclaimed. She hadn't been warm anywhere, didn't go to tanning salons, didn't use tanning products. She didn't know why her skin looked darker Really, she felt so terrible these days that she didn't even have the energy to wonder about it.

Bock knew that some of his patients did not immediately recognize their tanning habits. But he could see that this was not the case with this patient. He stepped out of the exam room and went to his office. He used his computer to look for causes of hyperpigmentation. Two rare diseases emerged immediately: hemochromatosis – a hereditary disease in which patients are born without the chemicals needed to get rid of excess iron. Over time, these patients have too much iron in their system. When it builds up in the pancreas, patients develop diabetes; Arthritis develops in the joints. And when it builds up in the skin, patients look darker.

The other disorder known to cause darkening of the skin is primary adrenal insufficiency (P.A.I.). The adrenal glands are triangular-shaped glands that are on top of the kidneys. The tiny organs get their instructions from a natural chemical, ACTH (adrenocorticotropin hormone), made in the pituitary gland of the brain. When ACTH is released into the circulation, the adrenal glands supply their hormonal loads, including adrenaline and cortisol, which help the body respond to biological stress such as illness, hunger, or fatigue. Another adrenal hormone, aldosterone, controls sodium levels and thus blood pressure. High levels of ACTH also stimulate melanocytes, the cells that make skin pigment.

In P.A.I. the gland and its machinery for making hormones are destroyed – usually by a misdirected immune system. Certain infections, including H.I.V., as well as tuberculosis and cancer, can also destroy the glands. The most common symptoms of this rare disease are nausea, weakness, and dangerously low blood pressure.

Bock hadn't seen a case of either disease. But both can kill if not diagnosed and treated. "This is a long shot," he told the patient, but it is well worth examining.

A few days later the first laboratories were back. These measured ACTH, the hormone that controls the adrenal glands. Usually a whisper from ACTH is enough to get your adrenal glands working. However, the woman's test showed that the hormone was practically screaming – and still not being heard. Her ACTH level – which is usually below 50 – was close to 2,000. And even at this level, the expected adrenal reaction hormone cortisol was barely detectable. She had primary adrenal insufficiency. The disorder, formerly known as Addison's disease, was first described by Thomas Addison, an English doctor, in 1855. Recently, the medical community has moved from eponyms referring to the discovering physician to names that describe the disorders themselves.

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