Addison's disease
Background
- Primary adrenal insufficiency
- Autoimmune disease (70-90%)
- Tuberculosis previously most common cause
- Other causes include infectious, metastatic cancer, lymphoma, adrenal hemorrhage, infarction, drugs
- Typically presents in adults between 30 and 50 years of age
- All ages, races, genders can be affected
- Higher incidence with other autoimmune deficiencies
Clinical Features
A Caucasian woman with Addison's disease
- Abdominal pain
- [[Weakness[[ and fatigue
- Salt craving
- Abnormal skin pigmentation - will often look patchy
- Addisonian crisis:
- Hypotension
- Neurologic symptoms: coma
Differential Diagnosis
- Corticosteroid withdrawal
- Secondary adrenal insufficiency - deficiency of ACTH (produced by the pituitary gland)
- Tertiary adrenal insufficiency - deficiency of CRH (produced by the hypothalamus)
Evaluation
Laboratory findings
- Hypercalcemia
- Hypoglycemia
- Hyponatremia
- Hyperkalemia
- Metabolic acidosis
- Low stimulation of the renal distal tubule by aldosterone = sodium wasting in the urine and H+ retention
Evaluation
- Chemistry
- Random cortisol, renin, and ACTH levels
- Do not wait for levels before starting treatment
- ACTH (cosyntropin) stimulation test
Management
- Hormone Replacement[1]
- PO hydrocortisone and fludrocortisone
Disposition
- New diagnosis: strong consideration for admission
- Crisis?: Consider admission based on electrolytes and clinical presentation
See Also
External Links
References
- de Herder WW, van der Lely AJ (May 2003). "Addisonian crisis and relative adrenal failure". Reviews in Endocrine and Metabolic Disorders 4 (2): 143–7.
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