Addison’s Disease

27/07/2013 by admin | Endocrine
  1. Chronic adrenal failure with myriad of vague symptoms = fatigue, weight loss, anorexia, abdo pain, diarrhoea, postural hypotension, hyperpigmentation (in scars, buccal mucosa, palms/soles)
  2. Can lead to acute adrenal failure (‘Addisonian/adrenal crisis’) = hypovolaemic shock, profound hypoglycaemia, coma and death.
  3. Ix:
    1. o Always suspect adrenal failure in shock with hyponatriemia (+/- hyperkalaemia).
    2. o Hyponatriemia only occurs in later stages of primary adrenal failure (not in secondary adrenal failure as the RAA system remains intact and functional).
    3. o Cortisol will be low or normal
    4. o ACTH is high in primary failure but low in secondary failure
    5. o Short synACTHen test: adrenal stimulation test using synthetic ACTH – fails to produce cortisol when given only once in adrenal failure from any cause.
    6. o Long synACTHen test: is given repetitively over 3 days, if adrenal glands are intact, will produce cortisol.
    7. o Adrenal antibodies are found in autoimmune Addison’s disease
    8. o Imaging/CT/biopsy can be used.
  4. Mx:
    1. o Acute adrenal failure: IV physiological fluids, IV hydrocortisone, monitor electrolytes, glucose and treat precipitating cause.
    2. o Chronic adrenal failure: glucocorticoid replacement with hydrocortisone 20mg/d in divided doses. If infection, surgery, intercurrent illness = use 40mg/d
    3. o In primary adrenal failure: mineralocorticoid replacement (fludrocortisone) 
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