Addison's Disease (primary adrenal insufficiency)

Question 1

Addison’s Disease Pathology

Answer 1

Hyposecretion of all adrenal steroid hormones (cortisol, aldosterone)

Question 2

Addison’s Disease Aetiology

Answer 2

6I’s

• Immune (auto)
• Invasion
• Infiltration
• Infection
• Infarction
• Iatrogenic

Question 3

Addison’s Disease Symptoms

Answer 3

• Fatigue, weakness
• Anorexia, weight loss
• Tanned skin and vitiligo
• Dizziness, syncope (postural hypotension)
• Myalgia, arthralgia
• N&V
• Altered bowel habit
• Abdominal pain
• Depression, psychosis
• Salt craving
• Gum disease

Question 4

Addisonian’s/Adrenal Crisis

Answer 4

• Acute, life-threatening presentation of Addison’s
• Triggers: infection, trauma, surgery, sudden steroid withdrawal
• Presentation: tachycardia, hypotension, hypoglycaemia, confusion

Question 5

Addison’s Disease Investigations

Answer 5

Screening

• Morning serum cortisol
• U&Es
• FBC

Diagnostic
- Short ACTH stimulation

Question 6

Addison’s Disease Management

Answer 6

Lifelong steroid replacement

• Glucocorticoid (oral hydrocortisone)
• Mineralcorticoid (fludrocortisone)

Patient education