Addison's

Question 1

What is Addison’s disease?

Answer 1

Low levels of Cortisol + Aldosterone due to destruction of adrenal tissue.

Question 2

Symptoms of Addison’s?

Answer 2

Mnemonic ADDISONS
Always Tired
Dizzy (standing)
Drop in BP (standing)
Inexplicable Weight Loss 
Skin colour change (bronze)
Only eating sparingly (anorexia)
No strength (limbs)
Sick (nausea)

Question 3

What is 2ndary Adrenal Insufficiency?

Answer 3

Low levels of cortisol due to suppressed ACTH production.

Question 4

Investigations for Addison’s/Adrenal insufficiency?

Answer 4

1) Blood Glucose: Low (Cortisol) AND U&Es: Hyperkalaemia + Hyponatraemia (Aldosterone)
2) Measure Cortisol + Aldosterone Levels (blood/urine)
3) ACTH stimulation test

Question 5

Interpreting ACTH stimulation test results.

Answer 5

No Increase in Cortisol: Addison’s

Increased Cortisol: Adrenals respond to ACTH = 2ndary Adrenal Insufficiency

Question 6

Managing Addison’s/Adrenal Insufficiency?

Answer 6

Steroid replacement

1) Hydrocortisone 15-25mg BD, avoid giving at night (insomnia).
2) Fludrocortisone 50-200mcg daily

Question 7

Signs of Acute Adrenal Crisis?

Answer 7

Hypoglycaemia, Shock (including oligouria) + Confusion

Question 8

Managing Acute Adrenal Crisis?

Answer 8

1) ABCDE
2) IV Fluids
3) IV Hydrocortisone - 100mg QDS
4) Glucose replacement + electrolyte management