Addison's Disease

Question 0

Causes

Answer 0

• 80% autoimmune adrenalitis
• TB
• Adrenal metastases (from lung, breast, renal cancer)
• Lymphoma
• Opportunistic infections – HIV
• Adrenal haemorrhage
• Congenital

Question 1

Primary adrenal insufficiency

Answer 1

• Usually presents insidiously
• Lean, tanned, tired, tearful, weakness, anorexia, dizzy, faints, flu-like myalgias/arthralgias, depression, psychosis, low-self esteem, N/V, abdo pain, diarrhoea/constipation, postural hypotension, pigmented palmar creases.
• More common in women (autoimmunity)
• Associated with vitiligo and other organ specific autoimmune diseases

Question 2

Adrenal crisis

Answer 2

• Usually precipitated by infection or trauma – emergency
• Occasionally caused by sudden withdrawal of steroid treatment
• Coma and hypotension
• Don’t wait for results of tests – but take blood for subsequent cortisol level
• FBC, U&E and blood cultures needed
• Check for hypoglycaemia and give IV dextrose if needed
• Treat with IV steroids, saline (Na depleting) and antibiotics

Question 3

Investigations

Answer 3

• Hypocortisolaemia – basal levels may be normal or show low morning level
• May need dynamic test of adrenal reserve to prove insufficiency – synacthen test
• Electrolytes often normal
• May show low Na and high K, especially in adrenal crisis

Question 4

Clinical findings in chronic adrenal insufficiency

Answer 4

• Non-specific symptoms: lassitude, nausea, abdominal pain, diarrhea
• Dizziness due to postural hypotension
• Pigmentation due to ACTH - hand creases, buccal mucosa, scars (increased ACTH cross-reacts with melanin receptors)
• Hypoglycaemia – due to loss of one of the main insulin anatgonists