EndocrinologyAddison’s Disease

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

JFK suffered from both Addison’s and hypothyroidism

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

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

On examinationLook for cutaneous and mucosal

hyperpigmentationCheck blood pressureLook for evidence of other autoimmune

disease

InvestigationsFBC, U&Es, LFTs, glucose, calciumVenous blood gas (may show normal anion

gap metabolic acidosis)Short synacthen test

ManagementWill depend on the aetiology but typically

includes glucocorticoids (hydrocortisone) +/- mineralocorticoid (fludrocortisone) replacement

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

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)