Addison's disease Flashcards
What is Addison’s disease?
Primary adrenal failure
What is the most common cause of Addison’s disease?
Autoimmune
TB, sarcoidosis
Damaged adrenal glands so reduced secretion of cortisol and aldosterone.
What is the level of cortisol in Addison’s disease
Low
What is the level of ACTH in Addison’s disease?
High
What is the level of aldosterone in Addison’s disease?
Low (compromised adrenal cortex so less cortisol and aldosterone produced)
What is the level of renin in Addison’s disease?
High (lack of aldosterone to reabsorb sodium and water so low bp detected by kidneys so more renin released)
What test is used to confirm adrenal insufficiency?
Short synacthen test.
synthetic ACTH given and blood cortisol is measure at baseline, 30 mins and 60 mins.
Failure of cortisol to rise less than double the baseline indicates primary adrenal insufficiency.
How do you manage Addison’s disease?
Hydrocortisone to replace cortisol.
Fludrocortisone to replace aldosterone
Steroid card and emergency ID tag.
How do you manage Addison’s disease and a cold?
Increase dose of steroid.
If diarrhoea and vomiting, need IM injection of steroid at home and likely admission for IV steroids.
What is an Addisonian crisis?
Acute presentation of severe Addisons:
reduced consciousness
hypotension
hypoglycaemia
Hyponatraemia (adrenal unable to make aldosterone
Hyperkalaemia (lack of aldosterone means less potassium excreted in urine)
What can trigger an Addisonian Crisis?
Infection, trauma, other acute illness, if patients abruptly stop taking long term steroids.
How do you manage an Addisonian crisis?
Intensive monitoring
Parenteral steroids = IV hydrocortisone
IV fluid resuscitation
Correct the hypoglycaemia
Careful monitoring of electrolytes and fluid balance.
Does Addison’s cause hyperpigmented skin?
Yes, high levels of ACTH.
What kind of antibodies are involved in Addison’s disease?
Anti-adrenal antibodies, target various components of adrenal cortex.
Anti-21-hydroxylase antibodies, target key enzyme in making cortisol