DEAR DR. ROACH: In early November 2021 my son, who is 30, was diagnosed with Addison’s disease and was treated with cortisol. He was doing well on that regimen. In March 2022 his blood sugar went up (300+), and he…
March 2022 his blood sugar went up , and he was diagnosed with Type 1 diabetes. As late as January his blood sugar was normal! We are told that it happens sometimes with Addison’s.
ANSWER: Both Addison’s disease and Type 1 diabetes are autoimmune diseases, where the body’s immune system destroys important tissues. In Addison’s disease, it’s the adrenal cortex, a gland that sits on top of each kidney and makes cortisol. In Type 1 diabetes, it’s the islet cells in the pancreas, which makes insulin.
The diagnosis of Addison’s disease can be tough to make. Fatigue is the major symptom, and so many things can cause that. When symptoms of fatigue persist beyond what is common for college students and others, it should be on the list a physician thinks about. The diagnosis can be made in a straightforward manner by an ACTH stimulation test, but considering the diagnosis in the first place usually is the hardest part of making the diagnosis.
ANSWER: A fistula is an abnormal connection between two structures. One common fistula is from the bowel to the skin. This can be deliberately created during surgery , or it can come as a result of bowel disease, such as Crohn’s. Other fistulae can exist between the bowel and the bladder, between the trachea and the esophagus, or practically any other adjacent structures you can think of.
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