addison's disease

Question 1

what is addison’s disease

Answer 1

autoimmune destruction of the adrenal glands
most common cause of primary hypoadrenalism in the UK

Question 2

presentation of addison’s disease

Answer 2

lethargy, weakness, anorexia, nausea and vomiting
weight loss
hyperpigmentation
vitiligo
loss of pubic hair
hypotension
hypoglycaemia
hyponatraemia and hyperkalaemia

Question 3

presentation of addison’s crisis

Answer 3

collapse
shock
pyrexia
hypoglycaemia
hyponatraemia and hyperkalaemia

Question 4

causes of primary hypoadrenalism

Answer 4

tuberculosis
metastases (lung cancer)
meningococcal septicaemia
HIV
antiphospholipid syndrome

Question 5

investigations for addison’s disease

Answer 5

ACTH stimulation test (short synacthen test)

if not available send 9am serum cortisol

Question 6

what is the short synacthen test and what do the results mean

Answer 6

plasma cortisol is measure before and 30 minutes after giving synacthen IM
failure of cortisol to double = addisons

Question 7

electrolyte abnormalities seen in addison’s disease

Answer 7

hyperkalaemia
hyponatraemia
hypoglycaemia
metabolic acidosis

Question 8

management of addison’s disease

Answer 8

hydrocortisone (20-30mg per day)
fludrocortisone

Question 9

management of addison’s during intercurrent illness

Answer 9

glucocorticoid dose should be double
fludrocortisone dose stays the same
take IM hydrocortisone if patient vomiting

Question 10

management of addison’s crisis

Answer 10

ABCDE
IM or IV hydrocortisone
IV fluids
correct hypoglycaemia and monitor electrolytes