Addisons disease

Question 1

Epidemiology of Addisons (adrenal insuficiency)

Answer 1

4/100,000 annually. all age groups M=F
becomes clinically apparent during metabolic stress or trauma
80% idiopathic (autoimmune)

Question 2

Aetiology of Addison’s

Answer 2

70% d/t idiopathic atrophy of the adrenal cortex, probably caused by autoimmune processes

Also d/t destruction of the adrenal gland by granuloma (eg, TB, histoplasmosis), tumor, amyloidosis, hemorrhage, or inflammatory necrosis.or Drugs
polyglandular deficiency syndrome w/ diabetes and/or hypothyroidism

Question 3

Pathogensis

Answer 3

Both mineralocorticoids and glucocorticoids are deficient

The adrenal glands are located on top of each kidney
and consist of the cortex and the medulla.

The cortex produces three types of hormones: so destruction as in Addison results in insufficiency.

1) androgens and oestrogen’s

affect  sexual  development  and reproduction
-
2) glucocorticoid  hormones -
(cortisol) maintain  glucose regulation
suppress the immune  response
provide for the response  to stress

3) mineralocorticoid hormones
(aldosterone) regulate sodium and potassium balance - loss of leads to increased water/Na loss

Insufflicency means over production of hormones that usually stimulate adrenal cortex ACTH - this shares a precussor with MSH- so increased precussor of increased ACTH production results in MSH - hence pigmentation

Question 4

Clinical Manifestations

Answer 4

insidious, usually progressive hypofunctioning of the adrenal cortex with hypotension and hyperpigmentation

Weakness (subsides with rest), fatigue, and orthostatic hypotension are early symptoms and signs

Question 5

Symptoms

Answer 5

Anorexia, nausea, vomiting, and diarrhea often occur. 
cold intolerance
extreme weakness
Unintentional weight loss
Darkening  of the skin
skin colour, patchy
Colour is unnaturally  dark in some locations
Paleness may also occur

buccal mucosa pigmentation

Slow, sluggish, lethargic movement
- inability to handle stress. cant respond
to needed changes in the blood pressure or heart rate

Salt craving

Question 6

Signs

Answer 6

diffuse tanning of exposed and, to a lesser extent, unexposed portions of the body, especially on pressure points (bony prominences), skin folds, scars, and extensor surfaces.

Black freckles are common on the forehead, face, neck, and shoulders.

Bluish black discolorations of the areolae and mucous membranes of the lips, mouth, rectum, and vagina occur.

Question 7

Complications

Answer 7

acute infection can lead to adrenal crisis with cardiovascular collapse. Other causes: trauma, surgery, and Na loss from excessive sweating

ss/sx
profound asthenia; severe pain in the abdomen, lower back, or legs; peripheral hypotension, vascular collapse; and, finally, renal shutdown with azotemia
Shock and fever may be the only signs

Question 8

Prognosis

Answer 8

Even after diagnosis and treatment, the risk of death is more than 2-fold higher in patients with Addison disease.

Cardiovascular, malignant, and infectious diseases are responsible for the higher mortality rate