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Addison's disease

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Definition

Addison's disease is also known as adrenal insufficiency, or hypocorticolism.

Epidemiology

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It isn't very common, but it is important to catch. Commonly seen between 30 and 50, in both men and women.

Pathophysiology

Generally, either a genetic failure, leading to low production of glucocorticoids and mineralocorticoids, or autoimmune attack on the adrenals. Autoimmune is the cause 90% of the time. Can also be caused by TB.

Risk Factors

  • Anyone with long term steroid use, as this suppresses the adrenals.
  • People suffering from sepsis.
  • Metastatic cancer.
  • Autoimmune disease.

Clinical Features

The key ones are hyperpigmentation and postural hypotension. If you read hyperpigmentation in an exam question, immediately think "Is this Addison's?". Other symptoms you might get:

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Medical Emergency - An Addisonian crisis can present with shock, and is a bit of an emergency, because it will kill them!

Investigations

Look for hyponatraemia, and screen for autoimmune conditions, with ESR, CRP, rheumatoid factor, and probably a whole lot more!

Management

Often there will just be glucocorticoid deficiency, so you would give hydrocortisone, around 20mg morning and 10mg evening.

In some cases there will be mineralocorticoid deficiency too, in which case electrolyte disturbances would be present, in which case you give fludrocortisone.

The important thing to do is remind them to take their steroids EVERY DAY otherwise they might have an Addisonian crisis!