Addison's

Question 1

define

Answer 1

AI disorder associated with the destruction of the adrenal cortex >90% destroyed before symptomatic, associated with other AI disorders

Question 2

presentation

Answer 2

anorexia, weight loss
fatigue, lethargy
dizziness and low BP
abdominal pain, vomiting and diarrhoea
skin pigmentation (ACTH) - BUZZWORD= tanned skin without being on holiday

Question 3

diagnosis

Answer 3

bloods: low Na, high K, hypoglycaemia
short synacthen test
high ACTH, high renin, low aldosterone
antibodies
imaging e.g. MRI, CT

Question 4

describe short synacthen test

Answer 4

measure plasma cortisol before and 30 minutes after IV/IM ACTH injection
the cortisol should double, if it does not then there is adrenal insufficiency
normal baseline >250nmol/L and post ACTH >550nmol/L

Question 5

management of primary

Answer 5

• do not delay treatment for diagnosis

- hydrocortisone and fludrocortisone (monitor BP and K+)

Question 6

education for Addison’s disease

Answer 6

sick day rules
do not stop suddenly
wear identification

Question 7

management for secondary

Answer 7

surgery

exogenous steroid use= prednisolone, dexamethasone, ICS act on CRH and ACTH affecting cortisol production

Question 8

what is clinically different about secondary disease?

Answer 8

no skin pigmentation as ACTH is not raised and aldosterone is intact

Question 9

management of secondary acute

Answer 9

hydrocortisone