Addison's disease: Difference between revisions
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*Higher incidence with other autoimmune deficiencies | *Higher incidence with other autoimmune deficiencies | ||
==Clinical | ==Clinical Features== | ||
*Abdominal pain | *[[Abdominal pain]] | ||
**Chronic nausea, vomiting, diarrhea | **Chronic [[nausea]], [[vomiting]], [[diarrhea]] | ||
*Weakness and fatigue | *Weakness and fatigue | ||
*Salt craving | *Salt craving | ||
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**Low stimulation of the renal distal tubule by aldosterone = sodium wasting in the urine and H+ retention | **Low stimulation of the renal distal tubule by aldosterone = sodium wasting in the urine and H+ retention | ||
=== | ===Diagnosis=== | ||
*Chemistry | *Chemistry | ||
*Random cortisol, renin, and ACTH levels | *Random cortisol, renin, and ACTH levels | ||
Revision as of 15:49, 28 July 2015
Background
- Primary adrenal insufficiency
- Bilateral adrenal destruction by tuberculosis used to be most common cause, now only accounts for 7-20% of cases
- Autoimmune disease 70-90%, remainder caused by infectious disease, metastasis or lymphoma, adrenal hemorrhage, infarction, or 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)
Diagnosis
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
Diagnosis
- 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.