Addison's disease

Question 1

What is Addison’s disease?

Answer 1

Primary adrenal failure

Question 2

What is the most common cause of Addison’s disease?

Answer 2

Autoimmune
TB, sarcoidosis
Damaged adrenal glands so reduced secretion of cortisol and aldosterone.

Question 3

What is the level of cortisol in Addison’s disease

Answer 3

Low

Question 4

What is the level of ACTH in Addison’s disease?

Answer 4

High

Question 5

What is the level of aldosterone in Addison’s disease?

Answer 5

Low (compromised adrenal cortex so less cortisol and aldosterone produced)

Question 6

What is the level of renin in Addison’s disease?

Answer 6

High (lack of aldosterone to reabsorb sodium and water so low bp detected by kidneys so more renin released)

Question 7

What test is used to confirm adrenal insufficiency?

Answer 7

Short synacthen test.
synthetic ACTH given and blood cortisol is measure at baseline, 30 mins and 60 mins.
Failure of cortisol to rise less than double the baseline indicates primary adrenal insufficiency.

Question 8

How do you manage Addison’s disease?

Answer 8

Hydrocortisone to replace cortisol.
Fludrocortisone to replace aldosterone

Steroid card and emergency ID tag.

Question 9

How do you manage Addison’s disease and a cold?

Answer 9

Increase dose of steroid.
If diarrhoea and vomiting, need IM injection of steroid at home and likely admission for IV steroids.

Question 10

What is an Addisonian crisis?

Answer 10

Acute presentation of severe Addisons:
reduced consciousness
hypotension
hypoglycaemia
Hyponatraemia (adrenal unable to make aldosterone
Hyperkalaemia (lack of aldosterone means less potassium excreted in urine)

Question 11

What can trigger an Addisonian Crisis?

Answer 11

Infection, trauma, other acute illness, if patients abruptly stop taking long term steroids.

Question 12

How do you manage an Addisonian crisis?

Answer 12

Intensive monitoring
Parenteral steroids = IV hydrocortisone
IV fluid resuscitation
Correct the hypoglycaemia
Careful monitoring of electrolytes and fluid balance.

Question 13

Does Addison’s cause hyperpigmented skin?

Answer 13

Yes, high levels of ACTH.

Question 14

What kind of antibodies are involved in Addison’s disease?

Answer 14

Anti-adrenal antibodies, target various components of adrenal cortex.

Anti-21-hydroxylase antibodies, target key enzyme in making cortisol