ADDISON'S DISEASE

ADDISON'S DISEASE

 It is also known as PRIMARY ADRENAL INSUFFICIENCY / HYPOCORTISOLISM


  • It is a long term endocrine disorder in which the adrenal glands do not produce enough steroid hormone(cortisol and aldosterone)
  • Leading cause  → Autoimmune destruction
  • most common cause in india → Tuberculosis of adrenals


 CLINICAL FEATURES :
Aldosterone decrease resulting in :
  • Salt wasting , craving for salty foods
  • polyuria (urine output >3L/day)
  • postural hypotension
  • hyperkalemia
  • metabolic acidosis


Cortisol decrease resulting in :
  • cortisol deficiency results in decreased blood sugar → palpitations,tremors,diaphoresis,RAGE attack,emotional fragility


ACTH increased :
  • Have partial melanocyte stimulating hormone like action resulting in
Hyperpigmentation at
  • palmar / sole creases
  • scars / areola / axilla / cubital fossa
  • groin area
  • oral mucosa
  • nails


DHEAS (Dehydroepiandrosterone sulfate) decreased resulting in :
  • decrease libido
  • erectile dysfunction




INVESTIGATIONS:
  • Sodium decreased and potassium increased
Rule out sampling errors as usage of thin bore needle may results in factitious hyperkalemia
  • CT abdomen - shows damaged adrenals
  • IOC :
ACTH stimulation / cosyntropin test
normally ACTH → Increase cortisol → blood sugar increase
In this disease, there is no raise of blood sugar levels


TREATMENT :
  • DOC - HYDROCORTISONE
  • Low BP is managed by giving - Fludrocortisone
  • Decreased sugar levels is managed by  - DEXAMETHASONE
  • ADDISONIAN CRISIS - I.V Hydrocortisone 

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