Addisons Disease


Addison’s disease is also known as primary adrenocortical insufficiency in which adrenal glands produces insufficient amount of cortisol or aldosterone due to various underlying causes.

Depending on the site of lesion,it is divided into two types:

It may be acute (adrenal crisis) or chronic (Addison’s disease)

PRIMARY ADRENOCORTICAL INSUFFICIENCY – ADDISON’S DISEASE

The disease is uncommon but is awell-recognized complication in patients with AIDS. Otherwise, it is commonly due to tuberculosis, fungal and cytomegalovirus infection. Autoimmune adrenalitis is the commonest cause of Addison’s disease. It is more common in females.

CAUSES:

COMMON CAUSE:

RARE CAUSE:

PATHOLOGICAL CAUSES:

 

SYMPTOMS:

 All the three zones of adrenal cortex are involved to some extent in Addison’s disease. The clinical picture is a blend of:

 

DIAGNOSIS:

Morning – low and evening low. A random cortisol <100 nmol/L during the day is highly suggestive and >550 nmol/L makes the diagnostic unlikely

Addison’s level – high

Pituitary or hypothalamus disease – low

Plasma cortisol at 30 or 60 mins <1gug indicates Addison’s disease.

MANAGEMENT:

The treatment is replacement therapy:

TREATMENT OF ADDISON’S DISEASE IN STRESSFUL CONDITION:

 

COMPLICATION:

 ADRENAL CRISIS: is defined as an acute precipitation of Addison’s disease under the effects of stress i.e., surgery, haemorrhage and infection. It is a medical emergency requires immediate treatment with corticosteroids (I.V hydrocortisone,mineralocorticoids,fluids , electrolytes and treatment of precipitating factors . Fluid replacement with normal saline /dextrose should be started immediately.

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