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Addison's Disease (Symptoms (Lethargy, depression, low mood & self…
Addison's Disease
Symptoms
Lethargy, depression, low mood & self esteem
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Diarrhoea, constipation and abdominal pain
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Pathophysiology
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Destruction of the entire adrenal cortex resulting in mineralocorticoid (aldosterone), glucocorticoid (cortisol) and sex steroid (androgens - precursors of sex hormones) deficiency
All steroids are reduced which differs from hypothalamic-pituitary disease in which mineralocorticoid and androgen secretion remains largely intact due to their relative independence from the pituitary
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Investigations
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Blood tests
- Hyponatraemia and hyperkalaemia due to decrease in aldosterone
- Hypoglycaemia due to low cortisol
- Hypoaldosternonism
- Low cortisol
- Uraemia
- Raised Ca ions
- Eosinophilia - since cortisol has anti-inflammatory effects, so reduction in cortisol results in raised white cell
- Anaemia
Treatment Plan
Adrenal crisis:
- Nausea, vomiting, abdominal pain, muscle cramps and confusion
- IV Hydrocortisone immediately
Replace steroids with daily - 3x a day to mimic circadian rhythm:
- Glucocorticoids e.g. oral hydrocortisone or prednisolone
- Mineralocorticoids e.g. oral fludrocortisone
- Warn against abrupt stopping steroids
- Double dose when infection/trauma/surgery/nightshifts
- Increase dose in pregnancy and before strenuous activity, mimics what the body would normally do
If patient is seriously ill or hypotensive on presentation:
- IV Hydrocortisone
- IV 0.9% Saline
- Glucose infusion if there is hypoglycaemia