Addisonian Crisis

Question 1

What is Addison’s disease

Answer 1

Disease of the adrenal cortex that causes hypo secretion is all three Adrina caudal hormones. Sugar, salt, sex. Most severe affect comes from lack of cortisol. Can’t be idiopathic, autoimmune or other

Question 2

What is primary Addison’s disease?

Answer 2

When the adrenal gland is destroyed. Symptoms start to occur when adrenal gland is 90% non-functional. Large amounts of ACTH & MSH secreted

Question 3

Clinical manifestations of Addison disease

Answer 3

Low sodium, dehydration, high potassium, hypotension, salt cravings, decreased cardiac output, decreased vascular tone, hypo cortisol ism leading to no energy. Hypoglycemia, weakness, fatigue, unsuppressed ACTH production causing hyper pigmentation (MSH)

Question 4

Addison’s disease treatment

Answer 4

Lifelong corticosteroid replacement therapy
Glucocorticoid (hydrocortisone)
Sometimes a mineralocorticoid (fludrocortisone)

Question 5

What are some important issues to remember when pharmacologically treating Addison’s disease

Answer 5

The dosing needs to mimic natural release of hormones. This entails proper timing and keeping the doses small. Never abruptly stop therapy in doses will need to be increased during times of stress. Always maintain an emergency supply. Where a medic alert bracelet

Question 6

What is the 3 x 3 rule

Answer 6

Increase dose 3x as much over three days in times of stress

Question 7

Causes of an addisonian crisis

Answer 7

Sudden insufficiency of serum corticosteroids which can result from:
Sudden loss of adrenal gland, sudden increase in stress, sudden cessation of long-term corticosteroid therapy

*most common with primary adrenal insufficiency

Question 8

Symptoms of an addisonian crisis

Answer 8

Sudden penetrating pain in the lower back, abdomen, or legs. This is usually due to hyponatremia
Severe vomiting and diarrhea, dehydration, low blood pressure, CNS changes, hyperkalemia causing ECG changes, hypo natremia

Question 9

What happens if an addisonian crisis goes untreated?

Answer 9

Possible death

Question 10

Treating addisonian crisis

Answer 10

IV Hydro Cortizone, sailing, dextrose

-When the patient is able, switch to PO medication influence in taper dose until maintenance dose is achieved