Addison's disease

Question 1

What are the two most important investigations for addison’s disease?

Answer 1

Morning serum cortisol and

ACTH stimulation test w/ synacthen

Question 2

List 5 symptoms for chronic Addison’s disease

Answer 2

Fatigue
Anorexia
Weight loss
Abdominal pain
Muscle and joint pain
Hyperpigmentation
Salt cravings

Question 3

List 5 symptoms of an acute addisonian crisis

Answer 3

hypotension or shock
vomiting
abdominal pain
fever
mental status changes

Question 4

Above what level is morning cortisol considered normal?

Answer 4

276 nanomols/L

Question 5

Below which level is morning cortisol classed as adrenal insufficiency

Answer 5

<83 nanomols/L

Question 6

Above which level should cortisol rise during ACTH stimulation test if there is secondary insufficiency?

Answer 6

497nmol/L

Question 7

If synacthen is given to someone with addisons, what happens to the cortisol

Answer 7

stays the same, or if partially damaged slightly increases but not above 497nmol/L

Question 8

Besides from cortisol, what else can you test for in Addisons?

Answer 8

FBC, blood urea and serum electrolytes

Question 9

What might you expect to see on a FBC in someone with Addison’s?

Answer 9

Eosinophilia

Anaemia

Question 10

What might you see when testing blood urea in someone with Addison’s?

Answer 10

Elevated blood urea

Question 11

What might you see in serum electrolytes in someone with Addison’s?

Answer 11

Na+ levels low
K+ levels high
Ca2+ levels high

Question 12

How would you manage Addison’s in the long term?

Answer 12

Prednisolone 3mg once daily OR hydrocortisone 2x daily (15-30mg max a day, with 2/3 of dose given in morning)

fludrocortisone: 0.1 to 0.2 mg orally once daily

Question 13

How would you manage an acute addisonian crisis?

Answer 13

IV fluids
hydrocortisone sodium succinate: 50-100 mg intravenously every 6-8 hours for 1-3 days
Dextrose 5% saline if needed to correct hypoglycaemia