DEAR DR. DONOHUE: I would like to know something about Addison’s disease. Is it inherited? Is there a cure? What medicine is used for it? What kind of doctor treats it? – M.R.

ANSWER: We have a right and left adrenal gland, each one sitting on top of a kidney. They produce an array of hormones necessary for life. Adrenal-gland hormones are involved with the metabolism of fats, carbohydrates and proteins. They keep blood pressure from falling too low. They assist the body in coping with both physical and mental stresses. They control inflammation. Cortisone is one adrenal-gland hormone.

In the past, TB was the major cause of adrenal-gland malfunction. Today, autoimmunity is the reason why they fail. Autoimmunity is a misdirected attack by the immune system on one of the body’s organs – in this case, the adrenal glands. It is not usually an inherited disorder.

Symptoms of adrenal-gland failure include overwhelming fatigue and profound muscle weakness. Almost always, a person’s appetite goes away and weight is lost. White skin takes on a tanned appearance. The elbows and palm creases of all races darken. Blood pressure can drop to levels below 80/50.

Lab tests reveal a blood deficit of sodium, chloride and bicarbonate along with a rise in potassium. To confirm the diagnosis, the doctor gives the patient a drug that should stimulate the adrenal-gland production of its hormones. People with Addison’s disease fail to increase their hormone production when given this drug.

There is a cure: replacing the missing hormone with two oral medicines. Cortisone is one drug that’s part of the program. The other hormone, fludrocortisone, corrects body chemistry and keeps blood pressure in the normal range.

The kind of doctor who specializes in treatment of Addison’s disease is an endocrinologist.

DEAR DR. DONOHUE: For the past two years I have had a problem in performing sexually. I am unable to attain an erection. I have seen a doctor, and he first gave me Viagra and then two other medicines. None worked. I am 62. Isn’t there something else that can be done? – R.M.

ANSWER: It’s important for a man with erectile dysfunction to find out if there is an underlying cause for it – diabetes, high blood pressure, medicines and so on. If there is none, then Viagra, Levitra and Cialis are three drugs that have revolutionized treatment of this common condition. They don’t work for all. There are other approaches.

Alprostadil injection is an alternate choice. The injection is made into the penis. That sounds most uninviting. However, the needle is thin, and the injection is neither painful nor difficult to administer.

Alprostadil also comes in pellet form. The pellets are inserted into the penis through a slender tube. Again, this sounds like barbaric treatment, but it is not. Pellet insertion is not hard to master.

Vacuum pumps help a man achieve an erection. They are cylinders that fit over the penis. When air is pumped out of the cylinder, a vacuum is created that causes blood to rush into the penis. An erection is attained without resorting to any medicine.

Finally there are a variety of surgical implants that can help a man overcome erectile dysfunction. A urologist can furnish you with details.

DEAR DR. DONOHUE: Will you please explain a rectocele and the procedure used to correct it? What are the pros and cons of such surgery? – G.N.

ANSWER: Aging, childbirth and straining to evacuate hard stool weaken the thin wall of tissue that lies between the rectum and the vagina. The weakened support causes the rectum to bulge into the vagina – a rectocele. A rectocele can cause problems in eliminating stool, and sometimes it can cause pain.

Surgery is the only answer. The major “pro” is correction of the problem. The “cons” include the kinds of complications inherent in all surgical procedures – infections, bleeding or trauma to adjacent tissues and organs.

Such complications are rare and should not deter you from surgical correction if the rectocele is troublesome.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.