Addison's Disease (Adrenal Insufficiency)

Question 1

Define the types of adrenal insufficiencies?

Answer 1

Primary = destruction/dysfunctional adrenal gland (Addison’s Disease)

Secondary = inadequate pituitary release = cortisol –

Tertiary = inadequate hypothalamic corticotrophin release hormone = ACTH –

Question 2

What are the causes of adrenal insufficiency?

Answer 2

Infection
-TB, meningococcal, systemic fungal, pseudomonas aeruginosa

Autoimmune

• Antibody against adrenal cortex
• Antibody against 21 hydroxylase

Tumours
Iatrogenic

Question 3

What are the risk factors for AI?

Answer 3

Female
Anticoagulants
Adrenal haemorrhage

Question 4

What are the symptoms of AI?

Answer 4

Fatigue
Anorexia
Salt craving
Weight loss
N+V
Arthralgia/myalgia

Question 5

What are the signs of AI?

Answer 5

Hyperpigmentation (of palmer creases) *
Hyperkalaemia
Hyponatraemia
Hypoglycaemia
Metabolic acidosis
Hypotension

Question 6

What are the investigations for AI?

Answer 6

SYNACTHEN High Dose ACTH stimulation
= 0 min cortisol <140nmol/L
= 30-60 cortisol <500nmol/L

ELECTROLYTES
=Na –
=K ++

FBC
Anaemia & eosinophil+

Question 7

What is the management of AI?

Answer 7

Patient education

• ID bracelet
• Steroid card
• Double dose for illness

MEDICAL

• Hydrocortisone (glucocorticoid)
• Mineralocorticoid replacement if needed