addison's disease

Question 1

what is addison’s disease?

Answer 1

primary adrenal gland insufficiency without any pituitary and hypothalamus problem

Question 2

causes of addison’s disease?

Answer 2

common: autoimmune, tb, hiv, bilateral adrenalectomy, drugs like ketoconazole, metyrapone and congenital adrenal hyperplasia
rare: lymphoma, waterhouse-firedrichsen syndrome, amyloidosis and haemochromatosis

Question 3

most common cause of acth defiency?

Answer 3

inappropiate withdrawal of chronic steroids therapy

Question 4

symptoms?

Answer 4

chronic: weakness weight loss, nausea vomiting, fever anorexia, constipation, abdominal pain, depression, impotence, postural hypotension, on examination there is hyperpigmentation, vitiligo, and hypotension, dehydration and wasting
acute: circulatory shock, hyponatremia, hperkalemia, muscle cramps,

Question 5

investigation?

Answer 5

baseline:
blood cp( neutropenia, esinophillia)
urea(increase)
electrolytes( low na, high K, high CA)
xray chest (tb) ct abdomen

Question 6

specific tests?

Answer 6

serum cortisol: less than 5mg is diagnostic in morning and increase ACTH with it
ACTH stimulation test: in secondary cortisol level increase but in addison no increase in cortisol after injecting ACTH
serum aldosteron: low with high plasma renin
anti-adrenal antibodies in autoimmune disease

Question 7

treatment:

Answer 7

glucocorticoids
fludrocortisone
DHEA to increase libido but cause acne and hirustism

Question 8

what is adrenal crisis?

Answer 8

sudden marked insufficiency of adrenal hormones

Question 9

causes of adrenal crisis?

Answer 9

stress, infection, trauma, surgery, prolonged fasting and sudden withdrawal of steroids

Question 10

clinical features of adrenal crisis?

Answer 10

dehydration, headache, confusion, coma, fever 105, sudden hypotension weak pulse, cold extremities

Question 11

D/D of adrenal crisis?

Answer 11

diabetic coma
CVA
acute poisioning
confusion and coma

Question 12

managemnt of adrenal crisis?

Answer 12

inject normal saline with 5% dextrose
hydrocortisone
antibiotics
managemnt of shock