Addison Disease

Question 1

Adrenal Gland

Answer 1

Medulla ( inner portion of Adrenal gland)
- Catecholamine: epinephrine & norepinephrine
Cortex (outer portion of Adrenal gland)
- Glucocorticoid: Cortisol
- Mineralocorticoids: Aldosterone
- Androgens

Question 2

What is Addison’s disease ?

Answer 2

Autoimmune Response
Adrenal tissue is destroyed by antibodies
All 3 Classes of Adrenal Corticosteroids are reduced
1. Glucocorticoids
2. Mineralocorticoids
3. Androgens

Question 3

What causes Addison’s disease?

Etiology

Answer 3

• Infarction - Fungal infections
• AIDS (Acquire immunodeficiency Syndrome)
• Metastatic Cancer - Chemotherapy
• Ketoconazole therapy: Used to treat Cushing Syndrome
• B/L adrenalectomy
• Adrenal Hemorrhage ( anti coagulation therapy)

Question 4

Clinical manifestations of Addison’s Disease I

Answer 4

• Hyperkalemia
• Hyponatremia
• Anorexia - Anemia
• Diarrhea
• Irritability - Depression
• ⬇️ muscle size & tone

Question 5

Classic manifestations of Addison’s disease

Answer 5

• Weight Loss
• Hyperpigmentation
• Vitiligo
• Hypotension
• ⬇️ Axillary & Public hair
• Fatigue

Question 6

Diagnostic testing for Addison’s Disease

Answer 6

• ACTH stimulation test: used to evaluate Adrenal function
• Electrolytes
• Glucose
• CBC, BUN, creatinine
• EKG (peaked T waves): Hyperkalemia
• CT scan, MRI: looking for tumor

Question 7

Pharmacological management of Addison’s Disease

Answer 7

• Replacement Therapy ( Hydrocortisol)
• Stressful situation: ⬆️ glucocorticoids (cortisol)
  
  • In order to Prevent Addisonian Crisis*
• Mineralocorticoid Replacement (Floinef)

Question 8

What is Addisonian Crisis?

Answer 8

A life- threatening emergency caused by INSUFFICIENT Adrenocortical hormone (ACTH)
Or
Sudden sharp ⬇️ in these hormones

Question 9

Addisonian Crisis clinical manifestations

Answer 9

• Circulatory collapse: corticosteroids = vasoconstriction
  No corticosteroids = Vasodilation
• Hypotension - Tachycardia
• Dehydration
• Hyponatremia, Hyperkalemia, Hypoglycemia
• Fever, confusion
• Weakness, Shock

Question 10

What causes Addisonian Crisis ?

Answer 10

• TRIGGERED STRESS !
• PostOp adrenal Surgery
• Pituitary Gland destruction
• Sudden withdrawal of Corticosteroids Hormone Replacement Tx

Question 11

Addisonian Crisis Treatment

Answer 11

• HIGH dose corticosteroid replacement
• Large Vol of NaCl & D5W
• VS Q30mins - Q4H for FIRST 24 HRS
• I&O
• Daily weights
• Protect from light & extreme environments

Question 12

Complications of Corticosteroids

Answer 12

• Hypertension
• Suppression of inflammation & immune response
• Inhibit the antibody response to vaccines
• Predisposition to PUD
• Mood & behavior changes
• Healing delayed
• Osteoporosis
• Redistribution of Fat