Addison's disease (hypocortisolism)
- Insidious onset : Weight loss, fatigue ± hypotension (NB postural).
- Occasionally skin pigmentation (MSH).
- Hypo-cortisol 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 pituitary- no skin pigmentation or hypokalaemia (mineralocorticoids levels okay)
- Diagnosed with low Serum/plasma cortisol (particularly early morning)
- May have transient hypocortisolism (morning level < 400nmol/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.
- Altered consciousness, 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 cortisol level measurement ± CXR then
- Hydrocortisone 200mg IV
- Correct dehydration, hyponatraemia and hypoglycaemia
- 2 litres saline in first 3 hours
- Close monitor glucose if unresponsive or intubated
Content by Dr Íomhar O' Sullivan 05/12/2010. Last review Dr ÍOS