Addison’s Disease

Addison’s Disease is a cortisol deficiency syndrome occurred due to various reasons such as Autoimmune disorders, Metastatic Cancers, Infarction, Amyloidsis,Tuberculosis,Hypoadrenalism in steroid therapy and pit. Disease.

Clinical features

• Pigmentation is often absent in auto immune disease but common in TB creases
• mouth scars, exposed areas, palms 
• Vitiligo 
• Weight loss, vomiting, diahrroea, non specific abdominal pain 
• Addisonian crisis : shock, hypotension, nyponatraemic due to infection of intercurrent disease 
• muscle cramps, myalgia 
• hypoglycaemia 
• postural hypotension

Other associations of Addisons disease are Type I Diabetes, Hypothyroidism, PA, hypoparathyroidism and premature menopause.

Investigations

• Inappropriately high ACTH in relation to a low plasma cortisol
• Stimulation of adrenal by tetracosactrin The plasma cortisol should rise to 600nmol/L in 45 mts.
• Adrenal auto antibodies
• Adrenal clacification in TB
• Hyponatraemia, hyperkalaemia, raised blood urea, anaemia, eosinophilia

Treatment

• In primary hypoadrenalism both cortisol and aldesterone has to be provided. In secondary hypoadrenalism only cortisol.
• Cortisol 30mg (20mg mane and 10mg vesper)
• (if not available cortisone acetate 25mg, prednisolone 5mg or dexamethazone 0.5mg/daily)
• Fludrocortisone 0.5mg daily