Addison's Flashcards
What is Addison’s disease?
An endocrine disease that is a result of hypoadrenalism, which leads to low levels of cortisol
Symptoms of Addison’s?
Weight loss, anorexia Fatigue, malaise, myalgia Fever Depression Diarrhoea, constipation, nausea/abdo pain Confusion
Signs of Addison’s?
Postural hypotension Pigmentation (skin creases, nail + gums) Dehydration Loss of body hair Fasting hypoglycaemia
Investigations for Addison’s?
U&E: hyperkalaemia, hyponatraemia, ↑ urea, metabolic acidosis, hypoglycaemia, hypercalaemia, normocytic anaemia
- Short synacthen test
- ACTH
What is the short synacthen test?
Give IM ACTH injection
Measure cortisol measurement at 0, 30 + 60 mins after injection
How to understand short synacthen test results?
Sufficient rise in cortisol = normal
Insufficient rise in cortisol = Addison’s
What is short synacthen test used for?
To diagnose Addison’s disease
How to understand ACTH results?
Low ACTH = secondary adrenal failure/exogenous glucocorticoids
High ACTH = primary adrenal failure
What are ACTH levels used for?
To determine whether Addison’s is caused by primary or secondary adrenal failure
Causes of primary adrenal failure?
Congenital adrenal hyperplasia Autoimmune (most) Haemorrhage TB infection Malignancy Infiltration (amyloid) Adrenalectomy
Causes of secondary adrenal failure?
Lesions of hyp/pit gland
Iatrogenic (sepsis/surgery causing acute exacerbation of chronic insufficiency)
Exogenous glucocorticoids
Management of Addison’s?
Hydrocortisone
Fludrocortisone
What is an Addisonian crisis (acute adrenal crisis)?
When the physiological demand for adrenal hormones exceeds the ability of adrenal glands to produce them
Symptoms of Addisonian crisis?
Nausea and vomiting Abdominal pain Diarrhoea Loss of appetite Fever
Signs of Addisonian crisis?
Hypotension
Hypoglycaemia
