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| Addisons disease |
Addisons disease
Addisons disease= primary causes 1 addisons disease2 congenital or acquired enzyme defects secondary causes 1. hypothalamic or pituitary 2.witgdrawal of glucocorticoid therapy.
Addisons disease-
causes-
1.Autoimmune adrenalitis-infectious adrenalitis,TB,fungal
2.Adrenal haemorrhage:-waterhouse-friderichsen syndrome,anticoagulation therapy,trauma.
3.Adrenal infarctiön-SLE,polyarteritis nodosa,antiphospholipid syndrom,trauma.
4.metastases in the adrenal-lung,breast,stomach carcinoma,lymphoma.
5.drug iduced-adrenolytic therapy.
6.congenital adrenal hyperplasia
7.bilateral adrenalectomy
8.amyloidosis
9.haemochromatosis
10.sarcoidosis
clinical features:-
1.clinical featurest results from glucocorticoid,mineralocorticoid,androgen deficiency & ACTH excess
2.cardinal features-hypotension,pigmentation,previous history of acute adrenal crisis
3.glucocorticoid deficiency result in malaise,weakness,weight loss,anorexia,nausea,vomitting.
4.mineralocorticoid deficiency manifest as hypotention
5.ACTH excess results in pigmentation of exposed areas,pressure area like elbows,knees&knuckle
6.androgen deficiency result in diminution of body hair especially in female and usually occurs with a secondary cause of adrenal insufficiency.
6.a number of autoimmune disease may be associated
7.the association of two or more of these endocrinopathies is known as type || polyglandular autoimmune syndrom.
9.the combination of adrenal insufficiency,hypoparathyroidism and chronic mucocutaneous candidiasis constitutes type l polyglandular autoimmune syndrom.
Investigation:-
1.elevated blood urea,hyponatraemia and hyperkalaemia
2.low blood sugar level
3.mild anemia,mild eosinophilia.
4.plasma cortisol measured between 8 and 9 am < 3 mg/dl suggets adrenal insufficiency while a level >19 ug/dl exclude it.
5.ACTH Stimulation test -there is failure of plasma cortisol to rise following adminstration of 250 ug of sythetic ACTH.
6.plasma ACTH Level are elevated(>100pg/dl) in primary adrenal insufficiency
7.plasma renin activity is high &plasma aldesteron level low or normal.
8.in tuberculous adrenalitis, chest radiograph may show evidancy of pulmonary TB.
9.adrenal and other specific antibody may be detected in the serum in autoimmune adrenalitis.
Manegment -
1.pt with disease require life löng glucorticoid & mineralocorticoid replacement therapy
2.cortison given at dose of 20mg on getting up in the morning and 10mg in the evening at 6 pm. Alternativly , prednisolone-5mg in am and 2.5mg at evening
3.fludrocortisone 0.05-0.1mg daily in pt with primary adrenal insufficiency
4.disease due to tuberculous adrenalitis treated with anti TB Chemotherapy.
5.during stress and infection-additional dose of prednisolone.
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