Addison's Disease Flashcards
2 types of pathophysiology
Primary
Secondary
Primary
Addison's disease Lack of - glucocorticoids - mineralocorticoids - androgens
Secondary
Lack of pituitary ACTH
Lack of glucocorticoids and androgens
Etiology and pathophysiology
Autoimmune response against adrenal cortex (body is attacking itself)
Causes of Addison’s
TB infarction fungal infections AIDS metastatic cancer latrogenic (drugs, adrenalectomy)
Clinical manifestations
It is an insidious onset with
- progressive weakness
- fatigue
- weight loss
- anorexia
- orthostatic hypotension
- hyponatremia and salt craving
- hyperkalemia
- N/V
- diarrhea
- hypoglycemia
- irritability, depression
When is Addison’s evident?
When 90% of the adrenal cortex is destroyed
Cannot reverse it at this point
Addisonian Crisis
Complication Acute adrenal insufficiency Insufficient or sudden, sharp decrease in hormones LIFE-THREATENING Various triggers
Addisonian Crisis can be caused by…
rapid stress onset or rapid ending of steroids
Manifestations of glucocorticosteroid and mineralocorticoid defiicencies
Hypotention Tachycardia Decrease sodium Increase potassium Decrease glucose Fever Weakness Confusion Severe vomiting, diarrhea, pain Shock = circulatory collapse
Diagnostic Studies
Decreased serum and urinary cortisol ACTH levels - increase in primary adrenal insufficiency - decrease in secondary adrenal insufficiency ACTH stimulation test Decreased urinary cortisol and aldosterone Increased potassium Decrease chloride, sodium, glucose Anemia Increase BUN ECG changes CT scan, MRI
ACTH stimulation test
Distinguishes between primary and secondary disease
- primary: no change
- secondary: increased cortisol
How do we fix it?
Correct underlying cause
Hormone therapy
-hydrocortisone (increase during periods of stress)
-fludrocortisone (if aldosterone deficient)
Increase dietary salt intake
Addisonian Crisis Care
Shock management High-dose hydrocortisone replacement H2 histamine blocker for ulcer prevention 0.9% saline solution and 5% dextrose Treatment for hyperkalemia Hypoglycemia management
Why do we have sodium wasting?
Because of lack of aldosterone
