addison disease

Question 1

In a patient with suspected Addison’s disease the definite investigation is

Answer 1

ACTH stimulation test (short Synacthen test). Plasma cortisol is measured before and 30 minutes after giving Synacthen 250ug IM.

Adrenal autoantibodies such as anti-21-hydroxylase may also be demonstrated.

If an ACTH stimulation test is not readily available (e.g. in primary care) then sending a 9 am serum cortisol can be useful:
> 500 nmol/l makes Addison’s very unlikely
< 100 nmol/l is definitely abnormal
100-500 nmol/l should prompt a ACTH stimulation test to be performed

Question 2

associated electrolytes abnormalities from addison disease ?

Answer 2

hyperkalaemia

hyponatraemia

hypoglycaemia

metabolic acidosis

Question 3

clinical features of addison disease ?

Answer 3

lethargy, weakness, anorexia, nausea & vomiting, weight loss, ‘salt-craving’

hyperpigmentation (especially palmar creases)*,

vitiligo,

loss of pubic hair in women = Thinning of pubic and axillary hair is seen in females with Addison’s disease due to reduced production of testosterones from the adrenal gland

hypotension, hypoglycaemia

crisis: collapse, shock, pyrexia

Question 4

other causes of primary adrenal insufficiency ?

Answer 4

tuberculosis

metastases (e.g. bronchial carcinoma)

meningococcal septicaemia (Waterhouse-Friderichsen syndrome)

HIV

antiphospholipid syndrome

Question 5

symptoms secondary to androgen deficiency, such as loss of libido and less hair is associate with which deficiency ?

Answer 5

DHEA - dehydroepiandrosterone