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Addison’s Disease

• Addison’s = Primary adrenocortical insufficiency
• More frequently in women than in men.

Causes

• Autoimmune problem is 80% of the cause.
• TB
• Genetic disorders
• Removal of adrenals
• Adrenal infarct
• Etc.

Clinical findings

• Sparse axillary and pubic hair
• Hyperpigmentation of skin especially of creases or pressure areas (waistband/bra line)
• Hypotension, generally systolic under 110 mmhg
• Small heart
• Salt craving
• There is a laundry list of vague findings including: weakness, fatigue, weight loss, anorexia, muscle and joint pain, amenorrhea, nausea and vomiting, hypotension, GI symptoms, delayed deep tendon reflexes, emotional changes

Labs

• Blood tests:
  • Cortisol is low
  • Sodium is low
  • Glucose is low
  • ACTH is elevated in primary adrenal disease
  • Potassium is elevated
  • Calcium is elevated
  • BUN is elevated
  • Antiadrenal and antithyroid antibodies may be present

Diagnosis

• Low plasma cortisol with elevated ACTH
• Cosyntropin (synthetic ACTH) stimulation test
  • Cosyntropin IV or IM
  • Cortisol levels should double in 30–90 minutes

Treatment

• Replacement with oral hydrocortisone or prednisone.
• Fludrocortisone is also useful for its sodium retaining properties
• DHEA may also be given

Adrenal Crisis

• A life threatening emergency caused by extremely low levels of cortisol.
• It may be a patient with Addison’s disease who has suffered trauma or surgery or has simply been poorly monitored.

Clinical Presentation

• These patients can present with all of the symptoms of Addison’s disease and…
• High fever
• Low blood pressure
• Confusion or coma
• Hypoglycemia
• Severe dehydration
• Weakness
• Pain in the lower back, abdomen and legs
• Renal shutdown

Labs & Studies

These are essentially the same as those listed for Addison’s disease.

Treatment

• IV fluid
• Immediate IV glucose
• Immediate IV hydrocortisone
• Once the emergent situation is over patient is moved to oral medications and will be treated as a patient with Addison’s disease.