Addison's disease/ Hypoadrenalism

 

Features of Addison's disease can be remembered as  "SynACTHEN"

  • SynACTHen test for Addison's disease
  • Skin & mucosal hyperpigmentation (hyperpigmentation of skin creases, lips, mouth & surgical scars)
  • Salt cravings in some patients
  • ACTH sky high in primary hypoadrenalism
  • Autoimmine adrenalitis as the main cause in western world, Amyloidosis
  • CXR may give a clue to the cause as in TB, so also the Calcification of adrenals in AXR (abdominal radiograph)
  • CAH as aetiology, Calcium high
  • TB probably remains the commonest cause worldwide
  • Thyroid dysfunction may be seen in primary (autoimmune) as well as secondary (TSH deficiency) hypoadrenalism 
  • Tumor infiltration as a cause
  • Hair loss in axilla and pubic areas in females
  • HIV as a cause
  • Hydrocortisone i.v as life saving in Addisonian crisis
  • Hypopigmentation / vitiligo
  • Hypotension and shock
  • Electrolyte disturbance - hyponatraemia, hyperkalaemia; Eosinophilia
  • NAGMA (normal anion gap met.acidosis), Normochromic normocytic anaemia, Neutropaenia
  • Nonspecificity : "the unforgiving  master of nonspecificity and disguise''
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imageIn the acutely ill patient in whom you suspect adrenal insufficiency do not delay treatment; establish venous access and give i.v hydrocortisone 100 mg immediately.
imageThyroid function abnormalities may revert to normal with satisfactory glucocorticoid replacement in Addison's disease
imageWhen present symptoms are often non-specific and the disease is sometimes only detected at post mortem leading to its description :"the unforgiving master of nonspecificity and disguise".

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