Addison's disease

• What is Addison's disease?

  Autoimmune destruction of adrenal glands
• What are Addison's patients deficient in?

  Cortisol and aldosterone
• How does the HPA axis relate to the type of Addison's?

  The cause

  Primary = adrenal gland

  Secondary = Pituitary

  Tertiary = Hypothalamus
• What are some causes of Addison's?

  Autoimmune

  Meds

  Infection

  Tumour
• When can you get an adrenal crisis?

  Steroid withdrawal

  Adrenal haemorrhage

  Sepsis/surgical exacerbation of insufficiency
• What are some symptoms of Addison's?

  Fatigue

  Myalgia

  Hyperpigmentation (especially in palmar creases)

  Salt craving

  Weight loss

  Abdo pain

  Hypotension
• What are some symptoms of adrenal crisis?

  Shock

  Pyrexia

  Collapse
• What are some signs and symptoms of Addison's in babies?

  Hyperpigmentation

  Jaundice

  Lethargy

  Poor feeding

  Hypoglycaemia
• What are some risk factors for Addison's?

  Female

  Antithrombotics

  PM/FHx of autoimmune disease

  Thromboembolic/hypercoagulable state
• What are some tests done for Addison's and what may you see?

  Metabolic acidosis

  Hyponatraemia and kalaemia

  ACTH (high in primary, low in central)

  Aldosterone (low in primary, normal in central)

  DHEA and DHEA-S (low)

  9am cortisol (low)
• How is Addison's managed medically?

  Fludrocortisone

  Hydrocortisone (2x dose if unwell)
• How is Addison's managed conservatively?

  Patient education

  Steroid alert bracelet/card
• How is adrenal crisis managed?

  IM hydrocortisone

  1L saline
• What is the most common cause of Addison's in the UK?

  Autoimmune