Addison's disease (primary adrenal insufficiency)

Question 1

What is Addison’s disease? (2)

Answer 1

Autoimmune impairment of the adrenal gland.

Leading to low cortisol + aldosterone

Question 2

What is the main cause of primary adrenal insufficiency worldwide?

Answer 2

Tuberculosis (TB)

Question 3

What is the main cause of primary adrenal insufficiency in the UK?

Answer 3

Addison’s disease

Question 4

What is a simpler way of thinking about Addison’s disease?

Answer 4

Its the opposite of Cushing’s disease!

Question 5

What are the clinical presentations of a pt w/ Addison’s disease? (4)

Answer 5

• Toned
• Tanned
• Tired
• Tearful

Question 6

For which 2 symptoms should you always consider Addison’s disease?

Answer 6

• Unexplained abdominal pain

- Nausea + vomiting

Question 7

How would you investigate Addison’s disease? (3)

Answer 7

• U&E: low Na+, high K+, low glucose
• ACTH stimulation test: cortisol remains low
• 21-hydroxylase adrenal autoantibodies

Question 8

How would a pt in an Addisonian crisis present? (3)

Answer 8

• Shock (due to low BP)
• D+V (lead to dehydration)
• Pain in back, abdomen or legs

Question 9

How would you treat a pt in Addisonian crisis? (2)

Answer 9

• Fluids

- Hydrocortisone (cortisol hormone)

Question 10

How would you treat Addison’s disease?

Answer 10

Give hormones: cortisol, aldosterone, androgens