Addison's

Question 1

What is Addison’s disease?

Answer 1

Primary adrenal insufficiency (eg. autoimmune or related to infection such as TB)- loss/degradation of adrenal cortex –> glucocorticoid & mineralocorticoid deficiency

Question 2

What’s aldosterone, where from, what responsible for?

Answer 2

mineralocorticoid, zona glomerulosa, Na+ & electrolyte control

Question 3

What’s cortisone, where from, what responsible for?

Answer 3

glucocorticoid, zona fasciculata, anti-inflammatory, metabolic, immunosuppressive effects, anti-inflammatory:Na+-retaining potency 1:1

Question 4

What therapy is a person with Addison’s on?

Answer 4

hydrocortisone (glucocorticoid:mineralocorticoid 1:1) & eventually fludrocortisone (glucocorticoid:mineralocorticoid 10:125)
Regimen to increase dose at times of stress/illness

Question 5

What’s an Addisonian crisis?

Answer 5

Inadequate glucocorticoid & mineralocorticoid available to meet the body’s needs–> hypovolaemia, hyponatremia, hyperkalemia & metabolic acidosis
also hypercalcaemia, hypoglycaemia, pro-inflammatory
most prominent manifestation= hypotension & shock
may also have nausea & vomiting, lethargy, confusion & even convulsions

Question 6

How to manage an Addisonian crisis intra-operatively?

Answer 6

Early recognition (art line useful- refractory hypoT)
Further stress steroid
infusion fluids, maintain BP with vasopressors +/- inotropes
correct electrolytes
Monitor ABG