Addison's Disease

Question 1

Primary adrenal insufficiency.

Destruction of the entire ? ? leading to glucocorticoid (?), mineralocorticoid (?), and ?-steroid deficiencies.
This differs from hypothalamic-pituitary (HPA) disease as HPA disease
generally spares ? production, which is stimulated by ATII.
o ? steroids are also largely independent of pituitary stimulation.

Answer 1

adrenal cortex
cortisol
aldosterone
sex
aldosterone
sex

Question 2

Aetiology;
o ?: 80% in the UK.
o ?: most common cause worldwide.
o Overwhelming ?.
o Metastatic cancer: ?/?.
o ?.
o Adrenal ?.
---> • ?-? syndrome

Answer 2

autoimmune
tb
sepsis
lung/breast
lymphoma
haemorrhage
waterhouse-friderichsen

Question 3

Symptoms are often vague and non-specific;
o Weight ?, malaise, weakness, ?.
o ?.
o ?.

Answer 3

loss
myalgia
depression
syncope

Question 4

Signs;
o ?, especially of new scars and palmar creases.
o ? hypotension.
o Signs of ?.
o Loss of body ?(particularly axillary/?).

Answer 4

pigmentation
postural
dehydration
hair
pubic

Question 5

Ix
o FBC: ?.
o U&Es: low ?, high ?, uraemia.
--• Due to ? insufficiency.
o ?: raised.
o Glucose: ? due to lack of ?

Answer 5

anaemia
sodium
potassium
mineralocorticoid
Ca2+
low
cortisol

Question 6

Ix

o ? ACTH ? test/ ? test.

• -• Give tetracosactide IM (? analogue).
• -• Measure plasma ? before and ? minutes after.
• -• A second value >550nmol/L ? Addison’s.

o ? ACTH / cortisol.
–• ? ACTH, ?/normal cortisol confirms Addison’s.

Answer 6

short
stimulation
synacthen
ACTH
cortisol
30
excludes
9am
raised
low

Question 7

Investigations for the cause;

• 21-? ? autoantibodies: autoimmune disease.
• ?: TB.
• Adrenal ?: to look for TB/ ? disease if ? negative.

Answer 7

hydroxylase adrenal
CXR
CT
met
antibodies

Question 8

Management;

o Long-term glucocorticoid cover;
• 15-25mg ? ?, in ? divided doses.
• Avoid giving ? in the day, as can cause ?.

o Long-term mineralocorticoid cover;
• Required if ? ?, ? sodium or ? potassium.
• ? 50-200 micrograms daily.

Answer 8

hydrocortisone
daily
3
late
insomnia
postural hypotension
low
high
fludrocortisone

Question 9

Mx
o Steroids should never be ? ?.
o Extra doses should be given for ? ?.
–• Double the dose for ?, ? illness or ?.
o Patient should have a ‘steroid ?’/ bracelet, and carry ? ? in case of Addisonian crisis.

Answer 9

abruptly stopped
strenuous exercise
surgery
febrile
trauma
card
IM hydrocortisone

Question 10

‘Addisonian crisis’.

Severely inadequate levels of ?, occurring either as a ? presentation of adrenal disease or triggered by physiological ?.
Presents with ?, nausea & vomiting, ?, ?,
hyper? and hypo?
Treat with ? ? and ? ? as part of resuscitation.

Answer 10

cortisol
first
stress
fever
shock
hypose
hypernatraemia
hypokalaemia
iv fluids
iv hydrocortisone