Addisons Disease

Question 1

What is addisons disease?
Production of which substances are reduced?

Answer 1

Primary adrenal insufficiency caused by destruction of the adrenal cortex
Glucocorticoids, mineralocorticoids and adrenal androgens

Question 2

T / F: adrenal insufficiency caused by long term administration of corticosteroids, or disorders of the hypothalamus or pituitary gland are Addison’s disease

Answer 2

False: other reasons for adrenal insufficiency NOT Addisons disease

Question 3

Give 5 scenarios where Addisons should be considered

Answer 3

1. Persistent, non-specific symptoms (fatigue, hyperpigmentation, GI symp, salt craving, postural hypotension, muscle cramps)
2. Hypothyroidism if symptoms worsen when thyroxine started
3. T1D with recurrent hypoglycaemia
4. Other autoimmune conditions
5. Low sodium and higher potassium

Question 4

What’s the most common cause of Addisons disease?

Answer 4

Autoimmunity

Question 5

When investigating adrenal insufficiency, what cortisol levels should you admit people and what what levels require more investigation?

Answer 5

Less than 100 nanomol/L - admit to hosp, adrenal insufficiency likely
100-500 nanomol/L refer to endocrine

Question 6

What test in secondary care confirms Addisons disease?

Answer 6

Andrenocorticotrophic hormone stimulation ( Synacthen) test

Question 7

What steroids are used to replace glucocorticoid and mineralocorticoid?
What product is used for androgen replacement?

Answer 7

Glucocorticoid replacement = hydrocortisone
Mineralocorticoid replacement = fludrocortisone
Androgen replacement = dehydroepiandrosterone

Question 8

Give 3 counselling/safety net points to Addisons patients

Answer 8

1 - increase corticosteroid cover during physical illness, such as illness, injury, or surgery to prevent adrenal crisis
2- recognise symptoms of adrenal crisis and know how to give IM hydrocortisone in emergency
3 - carry emergency info (steroid card)