Addison disease
Summary
Primary adrenal insufficiency with inadequate cortisol and aldosterone from destruction of >90% of the adrenal cortex, most commonly autoimmune. Classic: hypotension, hyponatremia, hyperkalemia, hyperpigmentation.
Detail
90% of cases in developed countries are autoimmune; remaining from TB, fungal infections, hemorrhage. Cortisol deficiency causes fatigue, weakness, hypoglycemia; aldosterone deficiency causes sodium wasting, hyperkalemia, hypotension. Hyperpigmentation from elevated ACTH stimulating melanocytes. Diagnosis: low cortisol with elevated ACTH, confirmed by ACTH stimulation test. Adrenal crisis requires high-dose IV hydrocortisone and fluids. Chronic: glucocorticoid (hydrocortisone) + mineralocorticoid (fludrocortisone) replacement.
Sources
- First Aid for the USMLE Step 1
- Pathoma
- Harrison's Principles of Internal Medicine
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