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Signs, Symptoms, Treatment of Addison's Disease

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  1. 1. (Addison’s Disease)
  2. 2. Case Scenario • A 34 year old woman presented with a 12 month history of increasing tiredness, anorexia, weight loss, and depression. During that period, she had tried two different antidepressant tablets without benefit. A short Synacthen (tetracosactide) test showed an inadequate serum cortisol response, which together with raised plasma adrenocorticotrophic hormone confirmed the diagnosis of Addison’s disease.
  3. 3. What is Addison’s disease? • Addison's disease is hypo function of the adrenal cortex. • Endocrine disorder also known as Adrenocortical Insufficiency. • There is a decrease in adrenal steroids which are: glucocorticoids, mineral corticoids, and androgen. • The adrenal cortex function is inadequate to meet the patients need for cortical steroids. • Addison’s disease occurs when 90% of the adrenal cortex has been destroyed
  4. 4. TYPES • There are three major types of adrenal insufficiency.  Primary adrenal insufficiency: is due to impairment of the adrenal glands.(Addison’s Disease)  Secondary adrenal insufficiency: is caused by impairment of the pituitary gland or hypothalamus.  Tertiary adrenal insufficiency: is due to hypothalamic disease and decrease in corticotropin releasing factor (CRF).
  5. 5. Signs and Symptoms 1. Fatigue and weakness. 2. Anorexia. 3. Nausea. 4. Vomiting. 5. Weight loss. 6. Abdominal pain. 7. Diarrhoea.
  6. 6. 8. Constipation. 9. Syncope. 10. Dizziness. 11. Confusion. 12. Personality change. 13. Irritability. 14. Darkening of the skin 15. Skin rash or lesions
  7. 7. Causes There are 3 main causes of adrenal insufficiency: • Autoimmune Disorders: The gradual destruction of the adrenal cortex, the outer layer of the adrenal glands, by the body's immune system causes up to 80 percent of Addison's disease cases. Adrenal insufficiency occurs when at least 90 percent of the adrenal cortex has been destroyed. As a result, often both cortisol and aldosterone are lacking • Tuberculosis: Tuberculosis (TB), an infection that can destroy the adrenal glands, accounts for less than 20 percent of cases of Addison's disease in developed countries.
  8. 8. Other Causes Less common causes of Addison's disease are: • chronic infection, mainly fungal infections • cancer cells spreading from other parts of the body to the adrenal glands • amyloidosis, a disease that causes abnormal protein buildup in, and damage to, various organs • surgical removal of the adrenal glands • AIDS-associated infections • bleeding into the adrenal glands • genetic defects including abnormal adrenal gland development, an inability of the adrenal gland to respond to ACTH, or a defect in adrenal hormone production
  9. 9. Diagnostic Tests Early stages difficult to diagnose. • Check Cortisol levels • ACTH Stimulation Test • CRH Stimulation Test • X-RAY • Fasting blood sugar • Serum potassium • Serum sodium
  10. 10. Case No. 1 • A 23-year-old female presented to the Emergency Department complaining of nausea and vomiting for one week. She also reported 8 months of progressively worsening fatigue. The patient was previously very active as a ballet student, but for the past 8 months she stopped participating in ballet because of lack of energy. She was now living with her mother and sleeping or watching television most of the day. She repeatedly denied purposefully restricting food intake or binging and purging behaviors. There was no abdominal pain, diarrhea, fevers, dysuria or headache.
  11. 11. •Diagnosis: The patient was diagnosed with primary adrenal insufficiency (Addison's disease) along with autoimmune hypothyroidism consistent with autoimmune polyendocrine syndrome type II. The severe hypovolemic hyponatremia was thought due to adrenal insufficiency.
  12. 12. Case No. 2 • A 24-year-old woman was acutely unwell with a background of several months of generalised fatigue and intermittent headaches. She had unremarkable neurological and systemic examination with a normal computerised tomography and magnetic resonance imaging of the brain. Normal cerebrospinal fluid but increased opening pressure at lumbar puncture suggested intracranial hypertension. A flat short synacthen test and raised level of adrenocorticotrophic hormone were consistent with primary adrenal failure.
  13. 13. •Diagnosis: Addison's disease is due to primary adrenal failure. It is an uncommon condition with equal prevalence in both males and females. The onset of symptoms is gradual and manifestation is non specific, hence diagnosis is easily missed without a high index of suspicion.
  14. 14. Treatment • Hydrocortisone Replacement Therapy: In adrenal crisis, patients need an immediate injection of hydrocortisone through a vein (intravenous) or muscle (intramuscular). You may receive intravenous fluids if you have low blood pressure.
  15. 15. Surgery • Patients with chronic adrenal insufficiency who need surgery with general anesthesia are treated with injections of hydrocortisone and saline. Injections begin on the evening before surgery and continue until the patient is fully awake and able to take medication by mouth. The dosage is adjusted until the maintenance dosage given before surgery is reached.
  16. 16. Physical Therapy Management (current best evidence) There are some key points for the physical therapy management of patients with Addison's disease: • Since these patients have a decreased response to stress, physical stress should be minimized as much as possible during activity and the treatment program should be "very gradually progressed" as the individual feels comfortable • Aquatics therapy should NOT be utilized with these patients because the heat and humidity of the pool will place increased demands of cortisol on their bodies to increase their blood pressure
  17. 17. • Vital signs should be constantly monitored, especially when initiating or progressing an exercise program • Monitor for the signs of an impending addisonian crisis, which includes "dizziness, nausea, profuse sweating, elevated heart rate, and tremors or shaking" • Patients should be referred back to the physician if there is a suspected infection, since an infection places extra stress on the patient