Addison's disease: Difference between revisions
| Line 21: | Line 21: | ||
==Diagnosis== | ==Diagnosis== | ||
*Hypercalcemia | ===Laboratory findings=== | ||
*Hypoglycemia | *[[Hypercalcemia]] | ||
*Hyponatremia | *[[Hypoglycemia]] | ||
*Hyperkalemia | *[[Hyponatremia]] | ||
*Metabolic | *[[Hyperkalemia]] | ||
*[[Metabolic acidosis]] | |||
**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 | ||
* | |||
* | ===Workup=== | ||
*Chemistry | |||
** | *Random cortisol, renin, and ACTH levels | ||
** | **Do not wait for levels before starting treatment | ||
**[[ACTH stimulation test]] | |||
==Management== | ==Management== | ||
Revision as of 22:40, 17 May 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
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
Workup
- Chemistry
- Random cortisol, renin, and ACTH levels
- Do not wait for levels before starting treatment
- 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.