Addison's

Addison’s disease
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Addison’s

Glucocorticoid deficiency
Mineralocoeticoid deficiency usually
Primary, secondary
Acute, chronic, acute on chronic
Autoimmune mostly

clinically

Low BM
Postural hypotension
N V D weight loss
Pigmentation
Reduced hair
May not be obvious until stressed
Reduced calcium very rare

lab

Low Na, high K & urea
Low BM
Elevated ACTH
SST- 250 microgram, 0, 30, 60 min cortisol level, >580 ug excludes diagnosis
Reduced renin activity
Reduced aldosterone
adrenal crisis
Precipitated by stress
Hypotension, low Na, High K, low BM
Can present similar to septic shock
Hypovolaemic picture

treatment

ITU
Hydrocortisone 200 mg stat, 100 mg qds
Fluid resuscitation
Glucose resuscitation
Inotropes
Dexamethasone if diagnosis not clear, as doesn’t interfere with cortisol level.
hypercalcaemia
Increased bone resorption
Hyperparathyroidism
Malignancy- metastasis, PTH like peptides, lymphoma, mm
Paget’s disease
Immobilisation
Increased GIT abs-
Intake- milk alkalli, antacids, Ca
Excess Vit D- vit D, TB, sarcoidosis, lymphoma
Decreased Output-
Renal failure
Thiazides
FHH

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