Addison's disease (hypocortisolism)



Background

  • 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.

Labs


Addisonian crisis

  • 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 5/12/18