Endocrinology Book

http://www.fpnotebook.com/

Addison's DiseaseAka: Addisonian Crisis, Adrenal Cortical Insufficiency, Adrenal Insufficiency, Adrenal Hypofunction, Illness Induced Adrenal Insufficiency, Stress Dose Steroid

Advertisement

  1. See Also
    1. Autoimmune Polyglandular Syndrome
  2. Pathophysiology
    1. Hypothalamic-Pituitary-Adrenal Axis (HPA) Dysfunction
      1. Lab features: Cortisol low, ACTH Low
      2. Causes
        1. Severe illness
        2. Exogenous Corticosteroid (suppression lasts months)
          1. Prednisone >7.5 mg/day for >3 weeks
          2. Dexamethasone >0.75 mg/day for >3 weeks
        3. Pituitary Infarction
        4. CNS Infection or tumor invasion
        5. Head Injury
        6. HIV Infection
    2. Adrenal Insufficiency
      1. Lab features: Cortisol low, ACTH high
      2. Causes
        1. Addison's Disease
          1. Primary adrenal failure of adrenal glands
        2. Idiopathic adrenal hypoplasia or destruction
          1. Granulomatous disease (e.g. Tuberculosis, Fungus)
          2. Amyloidosis
          3. Hemochromatosis
          4. Tumor
          5. Autoimmune process
        3. Medication medicated cortisol inhibition
          1. Etomidate
          2. Ketoconazole
  3. Symptoms
    1. Weakness
    2. Fatigue or Lethargy
    3. Nausea or Vomiting
    4. Diarrhea
    5. Abdominal Pain
    6. Weight loss
    7. Salt craving
    8. Altered Level of Consciousness (e.g. Delirium)
  4. Signs
    1. Fever
    2. Hyperpigmentation
      1. Skin with mottled areas of increased pigmentation
      2. Pigment at Buccal mucosa (Caucasian)
      3. Increased pigment in lips, vagina, rectum
    3. Reduced Hair Growth
    4. Postural Hypotension
    5. Signs of dehydration
  5. Labs
    1. Complete Blood Count
      1. Normochromic Normocytic Anemia
      2. Eosinophilia (helps differentiate from other causes)
    2. Chemistry Panel
      1. Hyponatremia
      2. Hypochloremia
      3. Hyperkalemia
      4. Hypoglycemia (helps differentiate from other causes)
    3. Urine 17-ketosteroids low
    4. Urine 17-Hydroxysteroids low
  6. Diagnosis
    1. Corticotropin Stimulation Test
      1. Failed adrenal response
  7. Management
    1. Acute
      1. IV Cortisol
    2. Chronic Replacement
      1. Hydrocortisone (glucocorticoid) AND
      2. Mineralocorticoid (9-alpha-fluorocortisol)
    3. Stress Dose Steroid
      1. Indication: Acute severe illness
        1. Serum Cortisol <15 to 34 mcg/dl
        2. Cortisol <9 after Corticotropin Stimulation Test
      2. Management
        1. Hydrocortisone 50 mg IV or IM q6 hours
        2. Consider adding fludricortisone 50 mcg qd
  8. Resources
    1. Addison and Cushing International Federation (ACIF)
      1. http://www.nvacp.nl/page.php?main=5
  9. References
    1. Cooper (2003) N Engl J Med 348:727

Adrenal gland hypofunction (C0001623)

Definition (CSP)abnormally diminished activity of the adrenal gland.
Definition (MSH)Conditions in which the production of adrenal CORTICOSTEROIDS falls below the requirement of the body. Adrenal insufficiency can be caused by defects in the ADRENAL GLANDS, the PITUITARY GLAND, or the HYPOTHALAMUS.
Definition (NCI)Adrenocortical hypofunction includes all conditions in which adrenal steroid hormone secretion falls below the requirements of the body. Adrenal insufficiency may be divided into two general categories: (1) those associated with primary inability of the adrenal to elaborate sufficient quantities of hormone and (2) those associated with a secondary failure due to a primary failure in the elaboration of adrenocorticotropin. (Harrison's Principles of Internal Medicine, 13th ed, p1970)
ConceptsDisease or Syndrome (T047)
EnglishAdrenal failure, Adrenal gland hypofunction, Adrenal Gland Insufficiency, Adrenal hypofunction, Adrenal Insufficiencies, ADRENAL INSUFFICIENCY, hypoadrenalism, HYPOFUNCTION ADRENAL, INSUFFICIENCY ADRENAL
Spanishhipoadrenalismo, hipofunción adrenal, hipofunción suprarrenal, hipofuncion adrenal, hipofuncion suprarrenal
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Addisonian crisis (C0151467)

ConceptsDisease or Syndrome (T047)
ICD9255.41
EnglishAcute adrenal insufficiency, Addisonian crisis, ADRENAL APOPLEXY, ADRENAL CRISIS, ADRENAL STORM, Adrenocortical crisis, CRISIS ADDISONIAN, CRISIS ADRENAL, Severe adrenal insufficiency
Spanishcrisis addisoniana, crisis suprarrenal, insuficiencia adrenal severa, insuficiencia suprarrenal aguda, insuficiencia suprarrenal severa
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Adrenal cortical hypofunction (C0405580)

Definition (NCI)The inability of the adrenal gland to produce adequate amounts of cortisol.
ConceptsDisease or Syndrome (T047)
ICD9255.4, 255.41
EnglishADRENAL CORTEX HYPOFUNCTION, ADRENAL CORTEX INSUFFIENCY, Adrenal cortical hypofunction, ADRENAL CORTICAL INSUFFICIENCY, Adrenal Insufficiency, Adrenocortical hypofunction, Corticoadrenal insufficiency, Hypoadrenocorticism, INSUFFICIENCY ADRENAL CORTEX
Spanishhipoadrenocorticismo, hipofunción adrenocortical, hipofunción de corteza adrenal, hipofuncion adrenocortical, hipofuncion de corteza adrenal, insuficiencia corticoadrenal, insuficiencia corticosuprarrenal, insuficiencia suprarrenal
CreditsDerived from the NIH UMLS (Unified Medical Language System)



Navigation Tree