Addisons Disease

Question 1

What is it and which hormones does it affect

Answer 1

adrenal insufficiency (hypoadrenalism)

resulting in reduced adrenocortical hormones:
mineralocorticoids (aldosterone)
glucocorticoids (e.g. cortisone)
androgens (testosterone)

most commonly autoimmune

Question 2

what does the adrenal gland make and which part makes what

Answer 2

adrenal cortex:
mineralocorticoids (aldosterone)
made in the zona glomerulosa

glucocorticoids (e.g. cortisone)
made in the zona fasciculata

androgens (testosterone)
made in the zona reticularis

adrenal medulla makes adrenaline/ noradrenaline

Question 3

who gets Addisons disease

Answer 3

it Is quite rare

affects females more than males

30-50

people with these diseases:
type 1 diabetes
vitiligo (loss of skin pigment)
hashimotos thyroiditis
autoimmune diseases e.g RA

Question 4

what is the aetiology of addisons

Answer 4

usually autoimmune

destruction of the adrenal glands

other causes can be HIV, TB, metastases

Question 5

what are the risk factors for addisons

Answer 5

type 1 diabetes
vitiligo (loss of skin pigment)
hashimotos thyroiditis
autoimmune diseases e.g RA

Question 6

how does it present

Answer 6

lethargy and general weakness
n and v 
weight loss 
cravings for salt
hyperpigmentation on palmar creases
body hair loss in females

Question 7

what causes secondary adrenal insufficiency

Answer 7

prolonged prednisolone use

pituitary adenoma

Question 8

how do you investigate addisons disease

Answer 8

ACTH and cortisol measurements- ACTH stimulation test is gold standard (blood test, shot of ACTH, another blood test)

U and Es to check K+ (raised) and Na+ (down)

CXR to rule out lung cancer

Question 9

how do you manage addisons disease

Answer 9

replace lost steroids

?excision

Question 10

what is an addisonian crisis

Answer 10

acute adrenal insufficiency

drop in adrenocorticoids (all 3 types)

e. g. due to sudden discontinuation of glucocorticoid medications
e. g. due to severe trauma/ infection