Addison's Disease Flashcards
What are examples of primary insufficiency disorders?
Addison’s disease
Congenital adrenal hyperplasia
Adrenal TB/Malignancy
Examples of secondary and tertiary insufficiency?
- Due to lack of ACTH stimulation
- Iatrogenic (XS exogenous steroid)
- Pituitary/hypothalamic disorders
What is Addison’s disease?
Autoimmune destruction of the adrenal cortex
What is the most common cause of primary adrenal insufficiency?
Addison’s disease
How quick is the progression of Addison’s disease?
90% of the adrenal cortex is destroyed before symptomatic
What other diseases is Addison’s disease associated with?
- T1DM
- AI thyroid
- Pernicious anaemia
Autoantibodies positive in __% of Addison’s disease sufferers
70
Presentation of Addison’s disease?
- Anorexia
- Wt loss
- Fatigue/lethargy
- Dizziness and low BP
- Abdominal pain
- Vomiting
- Diarrhoea
- Skin pigmentation
- Decreased mineralocorticoids (K+ retention, Na+ loss, hyperkalaemia, hyponatraemia, volume depletion/hypotension)
- Decreased glucocorticoids
- Crisis
Test results that would indicate Addison’s?
- Suspicious Biochemistry (low Na, high K and hypoglycaemia)
- ACTH levels are high in Addison’s
- Renin/aldosterone levels (renin high) (aldosterone low)
Investigations for Addison’s?
- Short synacthen test
- Presence of adrenal autoantibodies
Management of Addison’s?
- Do not delay treatment to confirm diagnosis
- Hydrocortisone as cortisol replacement
- Fludrocortisone as aldosterone replacement
What to give a patient who is unwell with Addison’s disease?
Hydrocortisone IV
Usual dosage of hydrocortisone for Addison’s?
15-30mg daily in divided doses
Mimic diurnal rhythm
What does hydrocortisone act to replace?
Cortisol
What does fludrocortisone act to replace?
Aldosterone replacement
