Addison's disease: Difference between revisions
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==Background== | ==Background== | ||
{{Addison's background}} | {{Addison's background}} | ||
*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 Presentation== | ==Clinical Presentation== | ||
*Abdominal pain | |||
**Chronic nausea, vomiting, diarrhea | |||
*Weakness and fatigue | |||
*Salt craving | |||
*Abnormal skin pigmentation - will often look patchy | |||
*Addisonian Crisis | |||
**Hypotension | |||
**Neurologic Symptoms: coma | |||
==Differential Diagnosis== | ==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== | ==Diagnosis== | ||
*Hypercalcemia | |||
*Hypoglycemia | |||
*Hyponatremia | |||
*Hyperkalemia | |||
*Metabolic Acidosis | |||
**Low stimulation of the renal distal tubule by aldosterone = sodium wasting in the urine and H+ retention | |||
*Testing | |||
**ACTH stimulation test | |||
***Dexamethasone | |||
****Does not cross-react with the assay | |||
****Can be administered concomitantly during testing | |||
==Management== | ==Management== | ||
*Hormone Replacement<ref>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.</ref> | |||
**PO hydrocortisone and fludrocortisone | |||
==Disposition== | ==Disposition== | ||
*New Diagnosis: strong consideration for admission | |||
*Crisis?: Consider admission based on electrolytes and clinical presentation | |||
==See Also== | ==See Also== | ||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
Revision as of 21:52, 3 April 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 Presentation
- Abdominal pain
- Chronic nausea, vomiting, diarrhea
- 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
- Hypercalcemia
- Hypoglycemia
- Hyponatremia
- Hyperkalemia
- Metabolic Acidosis
- Low stimulation of the renal distal tubule by aldosterone = sodium wasting in the urine and H+ retention
- Testing
- ACTH stimulation test
- Dexamethasone
- Does not cross-react with the assay
- Can be administered concomitantly during testing
- Dexamethasone
- ACTH 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.