Addisons

Question 1

What is it?

Answer 1

Primary adrenal insufficiency

1. destruction of adrenal cortex = deficiency in corticosteroids and mineralocorticoids
2. Anyone on steroids long enough to cause adrenal suppression is at risk

Question 2

Causes of addisons

Answer 2

1. 80% is autoimmune
2. TB
3. adrenal mets
4. lymphoma
5. exogenous steroids = Secondary adrenal insufficiency

Question 3

HPC

Answer 3

• lean, tanned, tired, tearful
• weakness, anorexia, dizziness, faints, low mood, psychosis
• abdominal pain!!
• pigmented palmar creases and buccal mucosa

Question 4

Examination

Answer 4

Pigmented pallor creases and buccal mucosa
postural hypotension
addisonian CRISIS = very low BP and Tachycardia

Question 5

Investigations

Answer 5

• low Na, high K
• low glucose
• SYNACTHEN test - cortisol should rise with sACTH
• Serum ACTH will be high in addisons
• Adrenal Autoantibodies
• CXR - signs of TB or mets

Question 6

Treatment:

Answer 6

Replace steroids - hydrocortisone and fludrocortisone in daily doses
IM hydrocortisone in adrenal crisis