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EndocrinologyAddison’s Disease
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Addison’s diseasePrevalence: 1 in 125,000First described by Dr Thomas Addison who
documented cases caused by tuberculosis. Most common cause now autoimmune in the
UK but remains TB worldwideAutoimmune Addison’s usually occurs between
age 20-50
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JFK suffered from both Addison’s and hypothyroidism
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SymptomsFatigue/weaknessPigmentation of skin (sun-exposed areas, armpits, nipples,
palmar creases, inside mouth, recent scars, pressure points e.g elbows)
Dizziness (from hypotension)Decreased appetite & weight lossOccasional nausea & vomiting, abdominal painsOccasional diarrhoea/constipationMuscle cramps/painVitiligo Cravings for salty food or drinkOligomenorrhoea/amenorrhoea in womenDepression/psychosis/low self-esteem The unforgiving master of non-specificity and disguise
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Consider JFK –
- Presented with two episodes of collapse secondary to hypotension as a child
- Frequent episodes of abdominal pain and recurrent diarrhoea
- Inability to gain weight for much of his life
- Diagnosed aged 30 with Addison’s
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On examinationLook for cutaneous and mucosal
hyperpigmentationCheck blood pressureLook for evidence of other autoimmune
disease
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InvestigationsFBC, U&Es, LFTs, glucose, calciumVenous blood gas (may show normal anion
gap metabolic acidosis)Short synacthen test
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ManagementWill depend on the aetiology but typically
includes glucocorticoids (hydrocortisone) +/- mineralocorticoid (fludrocortisone) replacement
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Follow-upPatient should wear Medic Alert bracelet Carry steroid card with themMust ↑ steroids for stenuous
activity/illness/injury/stressWarn patient against abruptly stopping steroidsShould have 100mg injectable hydrocortisone
at home in case of vomiting
Patients must be followed up yearly for BP & U+E checks
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Addisonian crisisPatient may present with; Hypotension Severe vomiting and diarrhoea Pains in the back and abdomenDehydrationCollapse (triggered by stresses such as
infection/ trauma/ surgery/ insufficient hydrocortisone for strenuous activity)