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Pathology
Glucocorticoid and mineralocorticoid deficiency due to failure of adrenal glands. .
Aetiology
Autoimmune - 90% of cases
Infections - TB, HIV
Congenital - Congenital Adrenal Hyperplasia
Malignancy – Lymphoma, metastasis
Infiltration - Amyloidosis or sarcoidosis
Vascular – Haemorrhage, infarction, anticoagulants, meningococcal sepsis
(Waterhouse-Friderichsen Syndrome), antiphospholipid syndrome.
Iatrogenic – Adrenalectomy
Drugs – Ketoconazole, busulfan, methadone
Signs
Hyperpigmentation, postural hypotension, muscle wasting, vitiligo .
Symptoms
Fatigue, weight loss, nausea, poor appetite, dizziness
Addisonian Crisis: Fever, vomiting, abdominal pain, hypotension, tachycardia,
collapse, coma and hypovolaemic shock.Investigations
Bloods: Hyponatraemia, hyperkalaemia, hypoglycaemia, TFTs, Coeliac screen,
serum cortisol (low), serum ACTH (raised), short synacthen test
Imaging: Chest X-ray, CT adrenals, bone density scan to monitor osteoporosis
Treatment
Hydrocortisone 10-20mg/day in divided doses – should be doubled when ill
Fludrocortisone 0.05-0.2 mg/day
Addisonian Crisis Treatment (5S’s) - Salt (saline), Sugar (Dextrose), Steroids,
Support, Search for precipitating cause
Prognosis
Life expectancy reduced by 10-20 years. Steroid over-replacement leads to increased morbidity
Adrenal crisis at presentation/intercurrent illness, steroid over-replacement, other autoimmune conditions
Key Facts
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Key References
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