Addison's Disease

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Addison's Disease

• uncommon
• Destruction of adrenal glands leading to under secretion of mineralocorticoids and corticosteroids (originally by TB)
• over secretion of ACTH in attempt to compensate
• risk of Addisonian Crisis

History

• malaise
• weight loss
• abdominal pain
• dizziness
• fever
• depression
• confusion
• impotence / amenorrhoea
• nausea / vomiting
• diarrhoea / constipation
• syncope
• myalgia
• joint / back pain

PMH

• Organ-Specific Autoimmune Disease

Examination

• Observation
  • Female (young to middle aged)
  • Thin / wasted
  • Pigmentation
    • skin  creases
    • mouth
    • scars
  • Postural hypotension
  • Loss of body hair
  • Additional Vitiligo

Differential Diagnoses of pigmentation

• Race
• Haemochromatosis
• Ectopic ACTH
• Sun tan
• Repeated Blood Transfusions

Investigation

• U&E
  • can be normal
  • Hyponatraemia
  • Hyperkalaemia
  • ↑ urea
• blood glucose
  • low / Hypoglycaemia
• short synacthen test
• long synacthen test
• 9am ACTH
  • >80ng/l
• adrenal antibodies
• chest / abdominal X-rays
• Hypercalcaemia
• Anaemia

Treatment

• replacement glucocorticoid
  • clinical wellbeing
  • restoration of normal weight
• Fludrocortisone

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