Addison's Disease (hypo-cortisol)

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

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