Adrenal Insufficiency (Addison Disease) Flashcards
Examination findings of Addison Disease
- Postural Hypotension
- Weight loss
- Dehydration
- Loss of axillary and pubic hair
- Vitiligo
- Tachycardia
- Skin hyperpigmentation
Management of Addisonian Crisis
Signs - Nausea, vomiting, diarrhoea, hypoglycaemia, hypercalcaemia
- IV Hydrocortisone 100mg
- No access? Prednisolone 40mg PO
- 0.9% NaCl 10-20ml/kg bolus
- Insert to large-bore cannulae
- Obtain blood glucose level
- ECG
- Immediate referral to Tertiary hospital
Overview of Addison Disease
Insufficient production of glucocorticoids and mineralocorticoids in adrenal cortex
Autoimmune-related atrophy of adrenal cortex
- Secondary causes? Infection, metastatic cancer, drugs.
- Symptoms
- Fatigue, anorexia, weight loss, postural hypotension, skin hyperpigmentation as well as vitiligo (autoimmune destruction of dermal melanocytes),
- Investigation findings
- EUC - Hyperkalaemia, Hyponatraemia
- Elevated plasma renin
- Elevated ACTH
- +’ve short synacthen test (Blunted cortisol response to tetracosacritin 30-60mins after injection.)
- 8AM serum cortisol
Monitoring a patient with adrenal insufficiency
Monitor serum Na, K and renin.
- Plasma renin concentration in higher normal reference range indicates adequate mineralocorticoid replacement
Glucocorticoid excess - Weight gain, facial puffiness, peripheral oedema, insomnia, low BMD, HTN, Hyperglycaemia
Glucocorticoid deficiency - Weight loss, lack of apppetite, progressive skin pigmentation, lethargy
Mineralocorticoid excess
- HTN, peripheral oedema, hypokalaemia, low plasma renin
Mineralocorticoid deficiency
- Postural hypotension, tachycardia, hyperkalaemia.
Monitor BMD every 2 years.
Self-care for addisons disease
- Alert bracelet or necklace
- Sick day management and increase in glucocorticoid dose
- Recognise early features of crisis (Nausea, vomiting, dehydration, hypotension)
- Carry injectable hydrocortisone when in remote area away from medical care.
