v
=
Addison’s disease = Adrenocortical insufficiency (failure).
v
Uncommon
v
↓
All cortical hormones &
ACTH.
Causes
1)
Autoimmune adrenalitis (90%):
Organ-specific auto-Abs + lymphocytes
à destruction of adrenal cortex.
2)
TB (<10%).
3)
Cancer metastases.
Clinical
Features
q
ACTH à Pigmentation:
esp of new scars, in exposed &
pressure areas.
q
Glucocorticoid
deficiency ® Symptoms are often vague:
Weakness,
tiredness, weight loss, anorexia,
hypokalemia.
q
Mineralocorticoid
deficiency
à Hypovolemia, Na+ loss,
K+ à Postural
systolic hypotension.
q
Androgen
deficiency à Loss of body hair, impotence, amenorrhea.
v
2
Fatal mechanisms:
U-Na+ à
¯
S-Na+
à
¯
ECV
à Hypovolemia
à
¯
BP
à ¯
CO
à Prerenal failre
à DEATH!
¯ U-K+ à
S-K+
à Cardiac arrhythmia à DEATH!
Investigations
1. A 0900h
P-ACTH level:
ACTH & ¯
Cortisol.
2. The
short ACTH (Synachten) stimulation test: Failure
of P-cortisol to rise!
3. Electrolytes
&
urea.
4.
PRA, but S-aldosterone ¯.
5. Adrenal
Abs.
6. Chest
& abdominal X-rays.
(for TB, calcified adrenals).
7. Blood
glucose ¯.
Treatment
q
Long-term
= Replacement glucocorticoid (Cortisol) & mineralocorticoid
(Fludrocortisone).
q
TB
must be treated if present.
N.B.
Patient is advised to carry a steroid card / wear a bracelet
written
by:
Khalid Bin Yaroof. FMHS, UAE University.
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