Download Addison Disease

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This lecture was conducted during the Nephrology Unit Grand
Ground by Medical Student rotated under Nephrology
Division under the supervision and administration of Prof.
Jamal Al Wakeel, Head of Nephrology Unit, Department of
Medicine and Dr. Abdulkareem Al Suwaida. Nephrology
Division is not responsible for the content of the presentation
for it is intended for learning and /or education purpose only.
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Addison
Disease
Ali Ibrahim Alsagheir
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Index :

Introduction

ADDISON disease


Definition

Pathophysiology

Clinical manifestation

Diagnosis

RX
Addison crisis
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Causes of adrenal insufficiency :

primary adrenal insufficiency
((ADDISON’sDISEASE)): The problem due to a disorder of
the adrenal glands themselves.

secondary adrenal insufficiency:
Inadequate secretion of ACTH by the pituitary gland .
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Diff. between primary & secondary:
Primary adrenal ins.
Secondary
(↑ACTH)
(↓ACTH)
Glucocorticoid insufficiency
Glucocorticoid insufficiency
Mineralocorticoid insufficiency normal
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
is a rare endocrine disorder,
first described by British
physician Thomas Addison.

1 in 100,000 people.

It occurs in all age groups
and affects men and women
equally.

> 90% of adrenal tissue is
destroyed .
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Etiology of Primary adrenal
insufficiency :

Autoimmune

TB

HIV/AIDS

Metastatic cancer

Bilateral Adrenalectomy

Rare: amyloidosis, inta-adrenal heamorrhage, lymphoma
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Clinical manifestations of chronic
adrenal insufficiency
symptoms
Frequency
Weakness, tiredness, fatigue
100
Anorexia
100
Gastrointestinal symptoms
92
Postural dizziness
6 -13
Muscle or joint pains
12
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Clinical manifestations of
chronic adrenal insufficiency
Sign
Frequency, percent
Weight loss
100
Hyperpigmentation
94
Hypotension (systolic BP <110
mmHg)
88-94
Vitiligo
20
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Clinical manifestations of
chronic adrenal insufficiency
Laboratory abnormality
Frequency
Hyponatremia
88
Hyperkalemia
64
Hypercalcemia
6
Azotemia
55
Anemia
40
Eosinophilia
17
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Diagnosis :
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Random Plasma Cortisol: usually low
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Acth Stimulation Test (short Synacthen test):

250 μg ACTH1-24 (Synacthen) by i.m. injection at any time of day
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Blood samples: 0 and 30 minutes for plasma cortisol

Normal subjects plasma cortisol> 460 nmol/l
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Inadrenal insufficiencycortisol level fail to increase.

Then see ACTH: high ((primary)) , low ((secondary))

Plasma renin and aldosterone
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Treatment:
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
Glucocorticoid replacement :
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Cortisol (hydrocortisone) is the drug of choice .

15 -25 mg/day in 2-3 divided does
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2/3 in morning , 1/3 afternoon
Mineralocorticoid replacement :


Fludrocortisone 0.05 – 0.2 mg/daily
Adjust both on clinical ground
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ADVICES:
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Intercurrent stress:
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
Surgery:


eg. Febrile illness - *2 does of hydrocortisone
150 -300mg parenteal hydrocortisone daily (in 3 divided doses)
Gastroenteritis:
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Parenteral hydrocortisone
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Instructed in the use of IM emergency hydrocortisone.

All ptn should wear a medical information bracelet.
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ADDISION CRISIS
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45y/o, female, c/o anorexia, not feeling well,
hyperpigmentation , lethargy, wt. loss for 1 year
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Now present to the E/R with severe diarrhea and loss of
consciousness
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On examination:
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Decrease BP , dehydration, hyperpigmentation, no axillary hair
Labs :
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Na = 124 , K= 5.9 , cl = 82 , HCO3= 17 , ph = 7.2
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ADDISION CRISIS

It is a medical emergency.
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Untreated, an Addisonian crisis can be fatal.
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therapy should be instituted immediately upon suspicion.
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Precipitating factor :
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Infection, trauma, surgery .
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Or sudden withdrawal of steriods.
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Clinical manifestations :
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SHOCK ((low blood pressure, tachycardia, oliguria))
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sudden penetrating pain in the legs, lower back or abdomen
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severe vomiting and diarrhea, resulting in dehydration
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loss of consciousness
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hypoglycemia
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ADDISION CRISIS
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Diagnosis :
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Serum Cortisol,
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confirmation by an ACTH stimulation test should be postponed
until the patient has recovered.
RX :
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IV HYDROCORTISONE SUCCINATE 100 MG/6H for 48 hour ,then
start oral .
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IV FLUID ((NORMAL SALINE AND 10% DEXTROSE ))
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Precipitating cause should be treated.
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