Addison's Disease

Question 1

What is Addison’s disease?

Answer 1

Addison’s disease, also known as primary adrenal insufficiency, is a rare condition where the adrenal glands do not produce enough cortisol and aldosterone.

Question 2

What are the main symptoms of Addison’s disease?

Answer 2

Fatigue, weight loss, muscle weakness, hypotension, hyperpigmentation, nausea, vomiting, and abdominal pain.

Question 3

What causes Addison’s disease?

Answer 3

It is most commonly caused by autoimmune destruction of the adrenal cortex. Other causes include infections (e.g., tuberculosis), metastatic cancer, and adrenal haemorrhage.

Question 4

What is the pathophysiology of Addison’s disease?

Answer 4

The destruction of the adrenal cortex leads to insufficient production of glucocorticoids (cortisol) and mineralocorticoids (aldosterone), disrupting metabolic and electrolyte balance.

Question 5

How prevalent is Addison’s disease?

Answer 5

It is a rare condition, with an estimated prevalence of 100-140 cases per million people in the UK.

Question 6

What are the main risk factors for Addison’s disease?

Answer 6

Autoimmune conditions, family history of adrenal insufficiency, and certain infections like tuberculosis.

Question 7

What clinical examination findings might indicate Addison’s disease?

Answer 7

Hyperpigmentation of the skin and mucous membranes, postural hypotension, dehydration, and generalised weakness.

Question 8

What investigations are used to diagnose Addison’s disease?

Answer 8

Initial investigations include serum cortisol, ACTH stimulation test, electrolytes, and glucose levels. Imaging (e.g., CT/MRI) may be used to assess adrenal gland morphology.

Question 9

What electrolyte abnormalities are seen in Addison’s disease?

Answer 9

Hyponatraemia, hyperkalaemia, and sometimes hypoglycaemia.

Question 10

What is the ACTH stimulation test and its role in diagnosing Addison’s disease?

Answer 10

It involves measuring cortisol levels before and after administering synthetic ACTH. A failure of cortisol levels to rise confirms adrenal insufficiency.

Question 11

What are the main differential diagnoses for Addison’s disease?

Answer 11

Secondary adrenal insufficiency, hypothyroidism, chronic fatigue syndrome, depression, and gastrointestinal disorders causing weight loss.

Question 12

How does Addison’s disease affect sodium and potassium levels?

Answer 12

Aldosterone deficiency leads to sodium loss (hyponatraemia) and potassium retention (hyperkalaemia).

Question 13

What are the signs of an Addisonian crisis?

Answer 13

Severe hypotension, hypovolaemic shock, abdominal pain, vomiting, and confusion.

Question 14

What are the types of management for Addison’s disease?

Answer 14

Management includes lifelong hormone replacement therapy with hydrocortisone (for cortisol) and fludrocortisone (for aldosterone).

Question 15

What is the conservative management for Addison’s disease?

Answer 15

Patient education on recognising symptoms of adrenal crisis and how to adjust steroid doses during illness or stress.

Question 16

What is the medical management for Addison’s disease?

Answer 16

Hormone replacement therapy with hydrocortisone and fludrocortisone. Additional doses during stress or illness are necessary to prevent adrenal crisis.

Question 17

Is there a surgical management option for Addison’s disease?

Answer 17

There is no specific surgical management, but surgical intervention may be needed for underlying causes such as adrenal haemorrhage or tumours.

Question 18

How does Addison’s disease impact glucose regulation?

Answer 18

Cortisol deficiency impairs gluconeogenesis, leading to hypoglycaemia, especially during fasting or stress.

Question 19

Why is hyperpigmentation a feature of Addison’s disease?

Answer 19

Increased ACTH levels stimulate melanocyte activity due to shared precursor molecules, leading to hyperpigmentation.

Question 20

How does Addison’s disease differ from secondary adrenal insufficiency?

Answer 20

Secondary adrenal insufficiency is caused by pituitary or hypothalamic dysfunction, leading to low ACTH levels, while Addison’s disease involves adrenal gland dysfunction.

Question 21

What lifestyle adjustments might someone with Addison’s disease need to make?

Answer 21

Patients need to carry a steroid emergency card, wear a medical alert bracelet, and adjust medication doses during illness or stress.

Question 22

How can Addisonian crises be prevented?

Answer 22

By adhering to prescribed steroid replacement therapy, recognising early symptoms, and increasing steroid doses during illness or stress.

Question 23

What is the role of fludrocortisone in Addison’s disease management?

Answer 23

Fludrocortisone replaces aldosterone, helping regulate sodium and potassium balance and maintain blood pressure.

Question 24

What infections are commonly linked to the development of Addison’s disease?

Answer 24

Tuberculosis and fungal infections such as histoplasmosis are associated with adrenal destruction leading to Addison’s disease.

Question 25

Why is an emergency injection of hydrocortisone critical in Addisonian crisis?

Answer 25

It rapidly restores cortisol levels, stabilising blood pressure, glucose levels, and overall metabolism during a life-threatening adrenal crisis.