Addison's Disease

Question 1

What is the definition of addison’s disease?

Answer 1

Primary adrenal insufficiency (decreased cortisol, aldosterone, DHEA)

Question 2

What is the pathophysiology of addison’s disease?

Answer 2

Destruction or dysfunction of the entire adrenal cortex, resulting in decreased synthesis of adrenocortical hormones

Question 3

What is the aeitology of addison’s disease?

Answer 3

• 80-90% of addison’s disease is autoimmune related
• antibodies against 21-hydroxylase enzymes
• infection (TB), haemorrhage, malignancy and medications too

Question 4

DDx?

Answer 4

Secondary and tertiary adrenal insufficiency (deficiency of ACTH and CRH)

Question 5

What is the presentation of addison’s disease?

Answer 5

-chronic Addison’s (progressive weakness, fatigue, nausea, vomiting, hyperpigmentation, hypotension) or acute addisonian crisis (prominent nausea, severe vomiting, syncope, confusion, sharp abdominal, leg or back pain, extreme hypotension, circulatory collapse, hypoglycaemia, pyrexia)

Question 6

What is the DDx for addisonian crisis?

Answer 6

• Adrenal suppression due to corticosteroid therapy

- secondary and tertiary adrenal insufficiency

Question 7

What is the management for chronic addison’s disease?

Answer 7

-glucocorticoid, androgen and mineralocorticoid replacement therapy

Question 8

What is the management for addisonian crisis?

Answer 8

• glucocorticoid therapy

- supportive therapy (correct hypotension)