Addison's disease: Difference between revisions
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==Background== | ==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 | *Typically presents in adults between 30 and 50 years of age | ||
**All ages, races, genders can be affected | **All ages, races, genders can be affected | ||
*Higher incidence with other autoimmune deficiencies | *Higher incidence with other autoimmune deficiencies | ||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 02:36, 22 October 2018
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
- 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.