addison disease

• addison disease is a primary adrenocortical insufficiency
• clinical presentation include: hypotension,fever,GIT disturbance,dehydration weakness acidoses,hyperkalemia,hyponatraemia,hypoglycaemia,depressed mentation
• the combination of hyponatraemia and hyperkalaemia suggest high possibility of primary adrenal insufficiency
• investigations: check serum levels whether in the morning or at time of clinical presentation. is cortisol is >450nmol/L this exclude hypoadrenalism-low secretion of hormones. if is 100-450 then do ACTH stimulation test.
• for ACTH stimulation test we give: ACTH depot,IM,1mg with blood sample per 1hour. after that check serum cortisol. for normal people cortisol >550nmol/L. if less suspect addison disease
• causes of hypoadrenalism can be sepsis
• medicine treatment for acute crisis: give hydrocortisol,IV,100mg 6hourly. then change fron IV to oral once the patient is stable
• to maintain intravascular volume(Bp): give sodium chloride 0,9%, IV with regular glucose monitoring, incase of hypoglycaemia give dextrose 50%
• combination of sodium chloride 0,9% and dextrose 5% can cause fluid overload
• for maintainance therapy(chronic): give hydrocortisone,oral.10mg morning and 5mg night. increase dose according to clinical responce max dose 20mg morning,10mg night