Addison's Disease Flashcards
what is addisons disease?
Addison’s disease, or primary adrenal insufficiency, is a disorder that affects the adrenal glands, causing decreased production of adrenocortical hormones (cortisol, aldosterone, and dehydroepiandrosterone)
what is the epidemiology of addisons disease?
More common in women
what is the aetiology of addisons?
In developed countries, most cases of the disease (80% to 90%) are caused by dysfunction of the autoimmune system, with antibodies directed against the adrenal cortex and/or 21-hydroxylase present in 60% to 90% of people with autoimmune dysfunction.
Tuberculosis is the most prevalent cause in many countries in which it is endemic.
what are the risk factors for addisons?
Female
Adrenocortical autoantibodies
Adrenal hemorrhage
Autoimmune disease, TB, non-TB bacterial infection, fungal infection, HIV, drugs inhibiting cortisol metastatic malignancy, coeliac, sarcoidosis
what is the pathophysiology of addisons?
Disease results from decreased production of adrenocortical hormones (aldosterone, cortisol, and dehydroepiandrosterone) as a result of either destruction of the 3 layers of the adrenal cortex (the glomerulosa, fasciculata, and reticularis) or disruption of hormone synthesis. Infiltrating diseases such as tuberculosis or metastasis can also cause destruction of the adrenal medulla.
what are the key presentations of addisons?
Presence of risk factors Fatigue Anorexia Weight loss Hyperpigmentation Salt craving
what are the signs of addisons?
Risk factors Anorexia Hyperpigmentation Hypotension Arthralgia and myalgia
what are the symptoms of addisons?
Fatigue Weight loss Salt craving Nausea Vomiting
what are the first line and gold standard investigations for addisons disease?
Serum electrolytes - low sodium, high potassium, elevated calcium
Blood urea - may be elevated
FBC - anaemia, eosinophilia
Morning serum cortisol - low (<83nanmols/L)
what are the differential diagnoses for addisons?
Adrenal suppression due to corticosteroid therapy
Secondary or tertiary adrenal insufficiency
Haemochromatosis
Hyperthyroidism
how is addisons managed?
Glucocorticoid and supportive therapy (in adrenal crisis) Glucocorticoid plus mineralocorticoid, temporary switch to stress dosing of glucocorticoid androgen replacement (for women with decreased labido)
how is addisons monitored?
Patients should be evaluated annually to judge adequacy of glucocorticoid and mineralocorticoid replacement. Annual laboratory examination should include plasma renin activity and potassium levels to monitor mineralocorticoid replacement.
what are the complications of addisons?
Secondary cushing’s syndrome
osteopenia/ osteoporosis
Treatment related hypertension
what is the prognosis of addisons?
Patients should receive replacement therapy for life. Adherence to treatment is high, since non-compliance results in uncomfortable symptoms. Furthermore, patients know that non-compliance is potentially life-threatening.
