Addison's Disease Flashcards
What is another name for addison’s disease?
Primary Adrenal insufficiency
What is the reason of primary adrenal insufficiency?
autoimmune destruction of the adrenal cortex
What is the main cause of primary adrenal insufficiency?
autoimmunity (80%)
others: TB, adrenal metastases, lymphoma, opportunistic infections (HIV)
What is the commonest cause of secondary adrenal insufficiency?
iatrogenic due to long term steroid therapy leading to suppression of the pituitary- adrenal axis.- only becomes apparent on withdrawal from steroids.
Other: decreased ACTH production
What are some symptoms of Addisons disease?
Often present late
tanned, lean, tired and tearful +/- weakness, anorexia, dizzy, faints, flu-like myalgia.
mood is often affected
NVD
Think addisons disease in all with unexplained abdomen pain or vomiting.
Describe the lab test results you would expect in Addisons disease
decreased Na and increased K (due to decreased mineralocorticoid) decreased glucose (decreased cortisol)
What test do you do if you want to diagnose Addisons?
Short synacthen test
What is the biggest complication of Addisons disease?
Addisonian crisis–>shock
How can you treat Addisons?
replace steroids and mineralocorticoids (aldosterone)
What can precipitate addisonian crisis?
sepsis or surgery causing an acute exacerbation of chronic insufficiency (Addison’s, Hypopituitarism)
adrenal haemorrhage eg Waterhouse-Friderichsen syndrome (fulminant meningococcemia)
steroid withdrawal
how do you manage a patient in Addisonian crisis?
Hydrocortisone 100mg im or iv
1 litre normal saline infused over 30-60 mins or with dextrose if hypoglycaemic
Continue hydrocortisone 6 hourly until the patient is stable.
No fludrocortisone is required because high cortisol exerts weak mineralocorticoid action
Oral replacement may begin after 24 hours and be reduced to maintenance over 3-4 days
