Addison disease (adrenal insufficiency)

Question 1

Causes

Answer 1

Chronic adrenal failure—usually autoimmune

Question 2

Features:

Answer 2

• fatigue
• a/n/v
• diarrhoea
• abdominal pain
• weight loss
• dizziness
• postural hypotension
• hyperpigmentation (mouth, hard palate, skin creases of palm)

Question 3

Investigations:

Answer 3

• K+ ↑
• Na+ ↓
• glucose ↓
• cortisol ↓
• short synacthen stimulation test (key test)
• adrenal autoantibodies

Question 4

Addisonian crisis

Answer 4

Notorious for delayed diagnosis with possible wasting and death

Addisonian crisis provoked by stress, e.g. infection, surgery.

Requires urgent resuscitation with IV fluids and hydrocortisone