Addison's disease: Difference between revisions
ClaireLewis (talk | contribs) No edit summary |
|||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Primary adrenal insufficiency | *Primary [[adrenal insufficiency]] | ||
*Autoimmune disease (70-90%) | *Autoimmune disease (70-90%) | ||
**Tuberculosis previously most common cause | **[[Tuberculosis]] previously most common cause | ||
**Other causes include infectious, metastatic cancer, lymphoma, adrenal hemorrhage, infarction, drugs | **Other causes include infectious, metastatic cancer, [[lymphoma]], adrenal hemorrhage, infarction, drugs | ||
*Typically presents in adults between 30 and 50 years of age | *Typically presents in adults between 30 and 50 years of age | ||
**All ages, races, genders can be affected | **All ages, races, genders can be affected | ||
| Line 12: | Line 12: | ||
*[[Abdominal pain]] | *[[Abdominal pain]] | ||
**Chronic [[nausea]], [[vomiting]], [[diarrhea]] | **Chronic [[nausea]], [[vomiting]], [[diarrhea]] | ||
*Weakness and fatigue | *[[Weakness[[ and fatigue | ||
*Salt craving | *Salt craving | ||
*Abnormal skin pigmentation - will often look patchy | *Abnormal skin pigmentation - will often look patchy | ||
*Addisonian | *Addisonian crisis: | ||
**Hypotension | **[[Hypotension]] | ||
**Neurologic | **Neurologic symptoms: [[coma]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Corticosteroid withdrawal | *[[Corticosteroid]] withdrawal | ||
*Secondary adrenal insufficiency - deficiency of ACTH (produced by the pituitary gland) | *Secondary adrenal insufficiency - deficiency of ACTH (produced by the pituitary gland) | ||
*Tertiary adrenal insufficiency - deficiency of CRH (produced by the hypothalamus) | *Tertiary adrenal insufficiency - deficiency of CRH (produced by the hypothalamus) | ||
| Line 44: | Line 44: | ||
==Disposition== | ==Disposition== | ||
*New | *New diagnosis: strong consideration for admission | ||
*Crisis?: Consider admission based on electrolytes and clinical presentation | *[[adrenal crisis|Crisis]]?: Consider admission based on electrolytes and clinical presentation | ||
==See Also== | ==See Also== | ||
Revision as of 15:12, 28 September 2019
Background
- Primary adrenal insufficiency
- Autoimmune disease (70-90%)
- Tuberculosis previously most common cause
- Other causes include infectious, metastatic cancer, lymphoma, adrenal hemorrhage, infarction, 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)
Evaluation
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
Evaluation
- 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.