Last week, my eight-year-old daughter was diagnosed with type 1. Her glucose has been fairly well controlled. Last night, she noticed a couple of dark spots on her torso. We called the doctor and she said it had nothing to do with diabetes (was a little too dismissive for my liking). We called the hospital again this morning and spoke to the nurse, who was going to check with the doctor and have not heard back yet. Research on the Internet suggests a possibility of diabetics being more susceptible to Addison’s disease. We are very worried about this and would like to know if this indeed an additional risk with diabetes and if this is something we should be concerned about.

Addison’s disease is an acquired disorder of the adrenal glands, whereby there is insufficient ability of these two glands to produce the critically important hormones–cortisol and aldosterone. One of the more common reasons to have this adrenal failure or insufficiency is an autoimmune process whereby the body’s own immune system produces antibody proteins that “attack” the adrenals. While autoimmune destruction is the most common cause of type 1 diabetes and, while there is certainly an increased incidence of other autoimmune diseases in those who have any autoimmune disease, fortunately, Addison’s disease is actually rather rare.

One of the consequences of primary adrenal insufficiency is an increasing pigmentation of the skin. This is not the best forum to discuss the mechanism of how this pigmentation change occurs, but suffice that it does. And if it does, it most commonly first occurs over areas of the skin that undergo “pressure.” Typical examples include the knuckles, palms/soles of feet, gum line, inner lining of the cheek of the mouth, around the nipples, old scars, scrotum and labia, and others. The increased coloring does usually become diffuse over the body, eventually. Spots on the back would not be typical, but it’s easy to point them out to your health care team at the next, routine follow-up visit. Addison’s can be screened for but, I’d emphasize that even if one had detectable antibodies against the adrenals, it does not mean that one has adrenal insufficiency.

DS