Addisons disease Flashcards
What?
Primary adrenal insufficiency caused by destruction of adrenal cortex
What does destruction of adrenal cortex cause?
Reduced production of glucocorticoids (e.g. cortisol), mineralocorticoids (aldosterone), adrenal androgens
Absence of cortisol -> inc production of ACH (negative feedback reduced)
What does decreased mineralocorticoids cause?
K+ retention, Na+ loss
Hyperkalaemia, hyponatraemia, volume depletion and hypotension
What does decreased glucocorticoids cause?
Hypoglycaemia
Who
Females»_space;
Causes?
Autoimmune (21 hydroxylase)
TB can cause in countries with AIDS
Associations?
AI thyroid disease
Perinicous anaemia
Vitiligo
T1DM
Clinical features of sudden crisis?
Precipitated by infection or stress Hypotension Hypovolaemic shock Delirium Reduced consciousness Acute abdominal pain Vomiting Headache Low- grade fever Muscle weakness Hypoglycaemia (esp in children)
Other symptoms?
Fatigue Hyperpigmentation GI symptoms MSK CV Headache Low grade fever Inc thirst/ urination Loss of axillary/ pubic hair (women) Anxiety or depression
What causes hyperpigmentation?
Excess ACTH
Where does hyperpigmentation occur?
Sun- exposed areas Pressure points Friction areas Palmar creases Mucous membranes
GI symptoms?
Weight loss Loss of appetite Premature satiety Nausea and vomiting Abdominal pain Cravings for salt
MSK symptoms?
Muscle weakness
Muscle cramps
Joint pain
Symptoms in children?
Prolonged neonatal jaundice
Failure to thrive
Delayed puberty
Investigations?
Adenocorticotrophic hormone stimulation (syncathen test) confirms
Response to syncathen test?
Normal response is increase in serum cortisol levels (500-550 nano mol/L after 30- 60 mins)
Other investigations?
Serum cortisol level Urea and electrolytes Bloods 09:00 plasma ACTH Autoantibodies Plasma renin and aldosterone levels
Urea and electrolyte results?
Sodium may be low
Potassium high
Normal does not exclude
Plasma renin and aldosterone levels?
Renin = high Aldosterone = low
Autoantibodies?
Antibodies against 21- hydroxylase
Management?
Glucocorticoid and mineralocorticoid replacement
Glucocorticoid replacement?
Hydrocortisone usually used – 15- 25mg
Prednisolone can be used
Mineralocorticoid replacement?
Fludrocortisone to replace aldosterone
50- 200micrograms
Children have much higher requirement & may need salt supplementation
Androgen replacement?
Dehydroepiandrosterone (DHEA)
Prescribed in uncertain circumstances
