Addison's disease

Question 1

What is addison’s disease?

Answer 1

Addison’s disease is inADequate ADrenocorticoids.

Question 2

Who does addison’s affect?

Answer 2

It is rare. Prevalence of 40-60million worldwide.

• F>M
• linked to autoimmune diseases in 80% of UK cases

Question 3

What are the symptoms of addison’s?

Answer 3

GI

• nausea/vomiting
• abdo pain
• diarrhoea or constipation

GENERAL:

• malaise
• weakness
• fever
• weight loss
• loss of appetite
• syncope (postural hypotension)

MENTAL:

• depression
• confusion

SEXUAL:

• impotence/
• amnenorrhoea

MSK:

• joint / back pain
• myalgia

Question 4

What are the signs of addison’s disease?

Answer 4

• pigmentation
• postural hypotension (due to hypovolaemia)
• weight loss
• general wasting
• dehydration
• loss of body hair

Question 5

What are the causes of addison’s disease?

Answer 5

VASCULAR:

• sepsis can decrease blood supply to adrenal cortex so less adrenocorticoids.
• Haemorrhage into adrenal gland - associated with meningitis.

INFECTIONS:

• TB
• infections linked to AIDs

TRAUMA:

AUTOIMMUNE
: 80% of cases

METABOLIC:
-decreased / interupted cholesterol delivery to adrenal gland. (cholesterol needed for cortisol production)

IATROGENIC:
Drugs - Ketoconazole

NEOPLASTIC:
metasteses

CONGENITAL:
- congenital adrenal hypoplasia

DEGENERATIVE:

• Amyloidosis (protein deposits in adrenal gland leads to decreased function)
• adrenoleukodystrophy (ALD)

ENDOCRINE:

• low ACTH
• hypopituitarism

Question 6

What investigations are done to confirm / exclude addisons?

Answer 6

-Single cortisol measurement (<100nmol/l suggests addisons, >500nmol/l exclude addisons.)

SHORT ACTH STIMULATION TEST:

• give ACTH. measure plasma cortisol before and after. If ACTH high and cortisol still low them primary hypoadrenalism (addisons)
• *in pregnancy cortisol may be falsely high.

-U+E’s :
show low Na+ , high K+ and high urea.

Blood glucose:
low / symptoms of hypoglycaemia

Adrenal antibodies (autoimmune cause)

Chest and abdo Xray (show tuberculosis / calcification in adrenal gland)

Plasma rennin and aldosterone —> rennin high but aldosterone low.

Hypercalcaemia and anaemia (after rehydration) this is the first clue to addison’s.

Question 7

What is the treatment / management for addisons?

Answer 7

Treat addisons as an emergency with immediate glucocorticoid / mineralcorticoid (to correct postural hypotension) replacement.

Treat underlying cause e.g. TB

Glucocorticoid therapy:
-hydrocortisone (20-30mg daily)

Mineralcorticoid therapy:
Fludrocortisone (50-300mg daily)