Addisons disease

Question 1

What are key diagnostic factors in the history and presentation

Answer 1

fatigue
anorexia
weight loss
hyperpigmentation
acute adrenal crisis- collapse with hypotension and tachycardia
salt craving

Question 2

What is addisons disease

Answer 2

autoimmune destruction of adrenal glands resulting in reduced cortisol and aldosterone

Question 3

What are some other diagnostic factors

Answer 3

nausea and vomiting
postural hypotension
axillary and pubic hair loss in women

bronze hyperpigmentation of skin particularly in creases

Question 4

What is the most common cause pof primary adrenal insufficiency

Answer 4

autoimmune
- occurs when adrenal glands have been damaged so less cortisol and aldosterone secretion

Question 5

What is secondary hypoadrenalism

Answer 5

results from inadequate ACTH and lack of stimulation of adrenal glands leading to low cortisol

Question 6

What are causes of secondary hypoadrenalism

Answer 6

results of loss/damage to pituitary gland
-tumours
-surgery to pituitary
-radiotheraphy
-Sheehans syndrome
-Trauma

Question 7

What investigations are required for diagnosis

Answer 7

ACTH stimulation test - short syncacthen test
– failure of cortisol to increase indicates primary adrenal failure

9am serum cortisol
->500nmol/L – means unlikely
-100-500 nmol/L - ACTH stimulation test

Question 8

What other blood tests/ invetsigations are required

Answer 8

serum electrolytes- hyponatreamia,hyperkalaemia

U and Es

FBC- anaemia, eosinophilia, lymphocytosis, neutropenia

plasma renin ( elevated )

serum aldosterone ( suppressed )

Question 9

What is the management of addison’s disease

Answer 9

Hydrocortisone - replaces cortisol

Fludrocortisone replaces aldosterone

Patients giving steroid card and ID tag

in acute illness hydrocortisone needs to be doubled

Question 10

What is an adrenal crisis

Answer 10

acute presentation of severe adrenal insufficiency - where absence of steroid hormones leads to life threatening emergency

Question 11

How may one present in an adrenal crisis

Answer 11

reduced consciousness
hypotension
hypoglycaemia
hyponatraemia and hyperkaleamia

Question 12

What is the management of an addisonian crisis

Answer 12

IM/IV hydrocortisone -
IV fluids
correct hypoglycemia - IV dextrose
careful monitoring of electrolytes and fluid balance

Question 13

What is the most appropriate glucocorticoid replacement regime

Answer 13

hydrocortisone - usually given in 2/3 divided doses

patients usually require 20-30mg per day

majority given in first half of the day