Addison's disease (hypocortisolism)
Background
- Insideous onset : Weight loss, fatigue +/- hypotension (NB postural).
- Occasionally skin pigmentation (MSH).
- Hypocortisol caused by:
- Long-term steroid treatment
- Adrenocortical disease (Addison's disease) (autoimmune, infections (tuberculosis, HIV), haemorrhage, metastatic deposits)
- Pituitary or hypothalamic disease (Tumour, trauma, infection, or ischaemia)
- If pitutiary- no skin pigmentation or hypokalaemia (mineralcorticoid levels okay)
- Diagnosed with low Serum/plasma cortisol (particularly early morning)
- May have transient hypocortisolism (moring level < 400 nmol/l) in a seriously septic patients
- Confirm with a short ACTH test should be performed.
- Beware those on chronic steroid therapy unless morning cortisol > 200 nmol/l.
Addisonian crisis
- Altered cosnciousness, hypotension, hypoglycaemia
- Usually a history recent nausea, vomiting
- Beware and treat for underlying trigger (sepsis, trauma, SCS)
- Check baseline bloods and save serum for later cortison level measurement +/- CXR then
- Hydrocortisone 200mg IV
- Corrrect dehydration, hyponatraemia and hypoglycaemia
- 2 litres saline in first 3 hours
- Close monitor glucose if unresponsive or intubated
