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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|In 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.|
|Thyroid function abnormalities may revert to normal with satisfactory glucocorticoid replacement in Addison's disease|
|When 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".|