Addison's disease Flashcards
What is Addison’s disease?
primary adrenal insufficiency
What happens in addison’s disease?
destruction of adrenal cortex leads to cortisol and aldosterone decrease
What are the causes of addison’s disease?
- 80% autoimmunity
- long term steroid therapy (happens when withdrawal) in hypo
- TB
What are RF for Addison’s disease?
- Female sex
- Presence of adrenocortical autoantibodies
- Adrenal Haemorrhage
- Use of anticoagulants 5. TB
What are symptoms and signs of Addison’s disease?
- Fatigue (described as weakness or tiredness)
- Anorexia
- Weight loss
- Nausea
- Vomiting
- Hyperpigementation (sun exposed areas- 95% of people) – due to high ACTH
- Hypotension
What is possible DDx for Addison’s disease?
- Adrenal suppression due to corticosteroid therapy
- Secondary or tertiary adrenal insufficiency (pituitary or hypothalamic lesions)
- Haemochromatosis
- Hyperthyroidism
- Occult malignancy
- Anorexia nervosa
What are possible complications of Addison’s disease?
- Secondary Cushing’s syndrome
- Osteopenia/osteoporosis
- Treatment related hypertension
What investigations do you do for Addison’s disease?
- Serum Electrolytes
- Blood Urea (may be elevated)
- FBC
- Morning serum cortisol
- ACTH stimulation test
- Low glucose due to low cortisol
What would serum electrolytes show in Addison’s disease?
- low sodium
- high potassium
- rarely elevated calcium
What would FBC show in Addison’s disease?
- anaemia present in 40% of patients
2. eosinophilia
What would morning serum cortisol show in Addison’s disease?
between 8am and 9am <83 nanomols/L
How may adrenal crisis show?
shock or hypoglycaemia
How do you treat adrenal crisis?
- Glucocorticoid
- Supportive therapy
- Fluid
What Glucocorticoid is used in adrenal crisis?
hydrocortisone sodium succinate: 50-100 mg intravenously every 6-8 hours for 1-3 days
What is the ongoing treatment for Addisons?
glucocorticoid plus mineralocorticoid
