+ This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student rotated...
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Transcript of + This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student rotated...
+This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student rotated under Nephrology Division under the supervision and administration of Prof. Jamal Al Wakeel, Head of Nephrology Unit, Department of Medicine and Dr. Abdulkareem Al Suwaida. Nephrology Division is not responsible for the content of the presentation for it is intended for learning and /or education purpose only.
+
Ali Ibrahim Alsagheir
Addison Disease
+Index :
Introduction
ADDISON disease Definition Pathophysiology Clinical manifestation Diagnosis RX
Addison crisis
+
Causes of adrenal insufficiency : primary adrenal insufficiency
((ADDISON’sDISEASE)):The problem due to a disorder of the adrenal glands themselves.
secondary adrenal insufficiency: Inadequate secretion of ACTH by the pituitary gland .
+Diff. between primary & secondary:
Primary adrenal ins. Secondary
(↑ACTH) (↓ACTH)
Glucocorticoid insufficiency Glucocorticoid insufficiency
Mineralocorticoid insufficiency
normal
+
is a rare endocrine disorder, first described by British physician Thomas Addison.
1 in 100,000 people.
It occurs in all age groups and affects men and women equally.
> 90% of adrenal tissue is destroyed .
+
+Etiology of Primary adrenal insufficiency :
Autoimmune
TB
HIV/AIDS
Metastatic cancer
Bilateral Adrenalectomy
Rare: amyloidosis, inta-adrenal heamorrhage, lymphoma
+Clinical manifestations of chronic adrenal insufficiency
symptoms Frequency
Weakness, tiredness, fatigue 100
Anorexia 100
Gastrointestinal symptoms 92
Postural dizziness 6 -13
Muscle or joint pains 12
+Clinical manifestations of chronic adrenal insufficiencySign Frequency, percent
Weight loss 100
Hyperpigmentation 94
Hypotension (systolic BP <110 mmHg)
88-94
Vitiligo 20
+
+Clinical manifestations of chronic adrenal insufficiencyLaboratory abnormality Frequency
Hyponatremia 88
Hyperkalemia 64
Hypercalcemia 6
Azotemia 55
Anemia 40
Eosinophilia 17
+Diagnosis :
Random Plasma Cortisol: usually low
Acth Stimulation Test (short Synacthen test): 250 μg ACTH1-24 (Synacthen) by i.m. injection at any time
of day Blood samples: 0 and 30 minutes for plasma cortisol Normal subjects plasma cortisol> 460 nmol/l Inadrenal insufficiencycortisol level fail to increase.
Then see ACTH: high ((primary)) , low ((secondary))
Plasma renin and aldosterone
+Treatment:
Glucocorticoid replacement : Cortisol (hydrocortisone) is the drug of choice . 15 -25 mg/day in 2-3 divided does 2/3 in morning , 1/3 afternoon
Mineralocorticoid replacement : Fludrocortisone 0.05 – 0.2 mg/daily
Adjust both on clinical ground
+ADVICES:
Intercurrent stress: eg. Febrile illness - *2 does of hydrocortisone
Surgery: 150 -300mg parenteal hydrocortisone daily (in 3 divided
doses)
Gastroenteritis: Parenteral hydrocortisone
Instructed in the use of IM emergency hydrocortisone.
All ptn should wear a medical information bracelet.
+ADDISION CRISIS
45y/o, female, c/o anorexia, not feeling well, hyperpigmentation , lethargy, wt. loss for 1 year
Now present to the E/R with severe diarrhea and loss of consciousness
On examination: Decrease BP , dehydration, hyperpigmentation, no axillary
hair
Labs : Na = 124 , K= 5.9 , cl = 82 , HCO3= 17 , ph = 7.2
+ADDISION CRISIS
It is a medical emergency.
Untreated, an Addisonian crisis can be fatal.
therapy should be instituted immediately upon suspicion.
Precipitating factor : Infection, trauma, surgery . Or sudden withdrawal of steriods.
+Clinical manifestations :
SHOCK ((low blood pressure, tachycardia, oliguria))
sudden penetrating pain in the legs, lower back or abdomen
severe vomiting and diarrhea, resulting in dehydration
loss of consciousness
hypoglycemia
+ADDISION CRISIS
Diagnosis : Serum Cortisol, confirmation by an ACTH stimulation test should be
postponed until the patient has recovered.
RX : IV HYDROCORTISONE SUCCINATE 100 MG/6H for 48
hour ,then start oral . IV FLUID ((NORMAL SALINE AND 10% DEXTROSE )) Precipitating cause should be treated.
+
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