Addison’s disease: primary hypoadrenalism Flashcards
What is Addison’s disease?
It is the destruction of the entire adrenal cortex. Therefore the production of glucocorticoid, mineralocorticoid and sex steroids are all reduced.
What is the cause of Addison’s disease?
- autoimmune disease
- tuberculosis
- haemorrhage/infarction
- infiltration
- Schilder’s disease
- surgical removal of adrenal gland
What are the symptom of Addison’s disease?
- weight loss
- muscle weakness
- depression/ low mood
- increased thirst,
- increased increased urination.
What is Addisonian crisis?
When a patient presents with multiple symptoms that have developed quickly.
This includes dehydration, pale and clammy skin, sweating, severe vomiting and diarrhoea, severe muscle cramping and weakness.
How is Addison’s disease diagnosed?
By doing these test:
- Biochemical abnormalities
- Serum cortisol
- Short tetracosactrin test
How is Addison’s disease treated?
Maintenance treatment is with long-term corticosteroid replacement therapy. It is important to
replace both the glucocorticoid and mineralocorticoid- cortisol and aldosterone.
Giving hydrocortisone alone does not provide sufficient mineralocorticoid activity and therefore
fludrocortisone is given as well to ensure complete replacement.
Hydrocortisone is given in two divided doses, the larger in the morning and the smaller in the
evening, mimicking the normal diurnal rhythm of cortisol secretion.
Acute hypoadrenalism needs urgent admission to hospital, where they will be administered intravenous fluids and intravenous hydrocortisone.
What advice and counselling should be given to patients with Addison’s disease?
- Carry a steroid card
- Advise on how to take steroid replacement therapy
- Wear a warning/alert bracelet
- Know how to increase your steroid replacement dose if suffering intercurrent illness
- Keep an emergency supply of hydrocortisone injection
