Addison's Disease

Question 1

What are examples of primary insufficiency disorders?

Answer 1

Addison’s disease
Congenital adrenal hyperplasia
Adrenal TB/Malignancy

Question 2

Examples of secondary and tertiary insufficiency?

Answer 2

• Due to lack of ACTH stimulation
• Iatrogenic (XS exogenous steroid)
• Pituitary/hypothalamic disorders

Question 3

What is Addison’s disease?

Answer 3

Autoimmune destruction of the adrenal cortex

Question 4

What is the most common cause of primary adrenal insufficiency?

Answer 4

Addison’s disease

Question 5

How quick is the progression of Addison’s disease?

Answer 5

90% of the adrenal cortex is destroyed before symptomatic

Question 6

What other diseases is Addison’s disease associated with?

Answer 6

• T1DM
• AI thyroid
• Pernicious anaemia

Question 7

Autoantibodies positive in __% of Addison’s disease sufferers

Answer 7

70

Question 8

Presentation of Addison’s disease?

Answer 8

• Anorexia
• Wt loss
• Fatigue/lethargy
• Dizziness and low BP
• Abdominal pain
• Vomiting
• Diarrhoea
• Skin pigmentation
• Decreased mineralocorticoids (K+ retention, Na+ loss, hyperkalaemia, hyponatraemia, volume depletion/hypotension)
• Decreased glucocorticoids
• Crisis

Question 9

Test results that would indicate Addison’s?

Answer 9

• Suspicious Biochemistry (low Na, high K and hypoglycaemia)
• ACTH levels are high in Addison’s
• Renin/aldosterone levels (renin high) (aldosterone low)

Question 10

Investigations for Addison’s?

Answer 10

• Short synacthen test

- Presence of adrenal autoantibodies

Question 11

Management of Addison’s?

Answer 11

• Do not delay treatment to confirm diagnosis
• Hydrocortisone as cortisol replacement
• Fludrocortisone as aldosterone replacement

Question 12

What to give a patient who is unwell with Addison’s disease?

Answer 12

Hydrocortisone IV

Question 13

Usual dosage of hydrocortisone for Addison’s?

Answer 13

15-30mg daily in divided doses

Mimic diurnal rhythm

Question 14

What does hydrocortisone act to replace?

Answer 14

Cortisol

Question 15

What does fludrocortisone act to replace?

Answer 15

Aldosterone replacement

Question 16

What must be monitored when a patient is on fludrocortisone?

Answer 16

BP and K+

Question 17

How to manage adrenal crisis?

Answer 17

• Fluids (normal saline)
• Steroids IV/IM hydrocortisone
• Underlying cause?
• If in doubt still treat