Addison's disease: adrenal insufficiency

Adrenal cortex destruction

Addison's disease results from primary adrenal insufficiency, most often autoimmune. Deficiency in cortisol and aldosterone.

Symptoms

Insidious onset: chronic fatigue, anorexia, weight loss, postural hypotension, abnormal pigmentation (palmar creases, scars, gums), salt cravings. Risk of acute adrenal crisis: medical emergency.

Diagnosis

Low morning cortisol, elevated ACTH, Synacthen test. Anti-21-hydroxylase antibodies. Look for other autoimmune diseases (thyroid, type 1 diabetes).

Treatments

• Hydrocortisone: 15-25 mg/day in 2-3 doses
• Fludrocortisone: 0.05-0.2 mg/day
• Dose adjustment in stress situations (rule of thirds, doubling)
• Mandatory emergency hydrocortisone kit

Education

Wear a medical alert bracelet, never skip treatment, know warning signs of adrenal crisis, train family to inject.