Chapter 49: Addison's Disease Flashcards
Name the organ that is not functioning properly in Addison’s disease.
the adrenal cortex
Describe the primary and secondary causes of Addison’s disease
Primary: reduction of glucocorticoids, mineralocorticosteroids, and androgens
Secondary: lack of ACTH, glucocorticoids, and androgens
Cite the cause of most cases of Addison’s disease in the United States.
Autoimmune response
Cite which classes of adrenal corticosteroids are reduced in Addison’s disease.
all three: mineral, gluco, and androgens
Describe autoimmune polyglandular syndrome and who is most commonly affected by this syndrome.
When addison’s disease is present with other co occurring endocrine conditions.
*T1DM
*autoimmune thyroid disease
*pernicious anemia
*celiac disease
(most common in white females)
List some causes of iatrogenic Addison’s disease. 5
(caused by medical tx)
*adrenal hemorrhage
*anticoagulant therapy
*chemo
*ketoconazole therapy for aids
*bilateral adrenalectomy
Explain why Addison’s disease is often advanced before it is diagnosed.
clinical manifestations do not tend to become evident till 90% of the adrenal cortex is destroyed
Describe hyperpigmentation that is indicative of increased ACTH. 3
*seen mostly in sun exposed skin, pressure points, and joins
*appears bronzed and smokey
*likely due to beta lipotropin that stimulates melanocytes
Describe an Addisonian crisis and 4 triggers of this life-threatening problem.
*acute adrenal insufficiency
*insufficient or sudden sharp decrease in hormones
*life-threatening emergency
*various triggers (stress, sudden withdrawal from corticosteroid hormone therapy, sudden pituitary gland destruction
Describe the ACTH stimulation test used to diagnose adrenal insufficiency. 4
*baseline levels of cortisol and ACTH
*IV synthetic ACTH given
*levels rechecked after 30 and 60 min
(elevated blood cortisol is norm, little to no increase in cortisol levels in Addison’s disease, high ACTH level is primary adrenal insufficiency)
Discuss other laboratory findings that may support a diagnosis of adrenal insufficiency.
corticotropin releasing hormone stimulation test: high ACTH w/ no cortisol = addison’s disease
Explain the importance of managing underlying causes, life-long hormone therapy, and avoiding Addisonian crises.
*manage underlying cause in order to tx properly
*lifelong hormone therapy: glucocorticoids and mineralocorticoids if done consistently pts can expect normal life expectancy. Women need androgen replacement
*Addisonian crisis: shock management, high dose hydrocortisone replacement, 0.9% saline solution and 5% dex
