Addison's disease

Question 1

Definition

Answer 1

Primary adrenocortical insufficiency

Where there is complete destruction of the entire adrenal cortex

Addisons disease leads to a marked lack of glucocorticoid and mineralocorticoid from the adrenal cortex
– symptoms do not manifest until at least 90% of the adrenal cortex has been destroyed

Question 2

Aetiology

Answer 2

More than 90% of cases are from destruction by organ-specific antibodies
– associated with other disease:
—- autoimmune thyroid disease
—- ovarian failure
—- pernicious anaemia
—- type 1 diabetes mellitus

Rarer causes:
– adrenal gland TB
– surgical removal
– haemorrhage
– malignant infiltration
– also radiation treatment for malignant infiltration

Seconadary:
– where the pituitary gland doesn’t produce enough ACTH

Tertiary:
– hypothalamic disease caused by

Question 3

Epidemiology

Answer 3

Rare disease (1 in 100’000)

Most cases present in young to middle aged adults

Women are affected more than men

Question 4

Clinical presentation

Answer 4

Insidious presentation with non specific symptoms (this makes the diagnosis challenging):
– lethargy
– tiredness
– weakness
– anorexia
– nausea
– vomiting
– diarrhoea

• loss of weight may be prominent

Early sign:
– postural hypotension caused by salt and water loss

Can present as an emergency (addisonian crisis):
– vomiting
– abdominal pain
– profound weakness
– hypoglycaemia
– hypovolaemic shock

Question 5

Prognosis

Answer 5

Prognosis is good as long as the diagnosis has been made and lifelong therapy can be given via a synthetic glucocorticoid