Addison's disease Flashcards

1
Q

what is Addisons disease

A

primary adrenal insufficiency

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2
Q

what hormones are affected in Addisons

A

cortisol and aldosterone

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3
Q

what part of the adrenal glands are destructed in Addisons disease

A

the adrenal cortex layers; zona fasciculata (cortisol) and zona glomerulosa (aldosterone)

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4
Q

what is the difference between Addisons and secondary adrenal insufficiency

A

Addisons is where there is destruction of about 90% of the adrenal glands so they are unable to produce steroid hormones.
Secondary adrenal insufficiency is due to hypothalamic or pituitary involvement; decreased ACTH release so decreased activation of adrenals to release hormones

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5
Q

two presentations

A

acute (addisonian crisis) and chronic

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6
Q

aetiology

A

autoimmune, tuberculosis or metastasis (rarer)

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7
Q

risk factors

A

female sex, infiltrating diseases such as TB

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8
Q

how does Addisons disease present

A

postural hypotension, hypoglycaemia, weight loss, anorexia, weakness, hyperpigmentation, fatigue, nausea and vomiting

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9
Q

why do Addisons patient present with hyperpigmentation

A

increased POMC, increased ACTH and MSH

REFER TO HPG AXIS and NEGATIVE FEEDBACK

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10
Q

how can you tell if a patient is in addisonian crisis

A

confusion, reduced consciousness, delirium, hypotensive shock, tachycardia, pale, cold and clammy, oliguria

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11
Q

investigations

A

to confirm a diagnosis of Addisons; 9AM cortisol test,

serum electrolytes, blood urea, FBC

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12
Q

9 am cortisol test results

A

Addisons; less than 100nmol/L

non Addisons; more than 550 nmol/L

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13
Q

serum electrolytes in Addisons

A

high potassium, low sodium and RARELY high calcium

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14
Q

blood urea in Addisons

A

high

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15
Q

FBC findings in Addisons

A

anaemia and eosinophilia

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16
Q

management of acute presentation of Addisons (addisonian crisis)

A

IV fluid rehydration, glucocorticoids (hydrocortisone sodium succinate) and safely administer glucose by giving saline with 5% dextrose

17
Q

management of chronic Addisons

A

glucocorticoid replacement with hydrocortisone

mineralocorticoid replacement with fludrocortisone

18
Q

advice given to those with addisons

A

steroid warning card, medic-alert bracelet and keep emergency hydrocortisone on hand

19
Q

possible complications of Addisons

A

secondary cushings syndrome (excess glucocorticoid), osteopenia and osteoporosis (excess glucocorticoid), treatment related hypertension (excess mineralocorticoid)

20
Q

prognosis

A

adrenal function rarely will recover however normal life expectancy if they are treated properly