Addison disease just random collection of topic Addison's warnnning iam just human ,not all content 100 percent correct source Harrison

1. case
18 yrs. old male known as Addison and hypothyroidism since 2 yrs on prednisolone 15 mg od ,Thyroxine 25 mg ,Fludrocortisone .1mg
Pt admitted from OPD as Asymptomatic hyponatremia on 24/10/2019
-Medical history :
Patient was presented to king Fahad 2 yrs. ago with history of
Chronic general abdomen pain for 3 months dull in nature 5/10 in severity no aggravation or reliving factors associated with nausea and vomiting food
particle around 3 to 4 times per week and loss of weight around 10 kg ,Fatigue and general muscular weakness and Sudden dizziness on standing
position ,no muscle cramps ,Hyperpigmentation of face and both hands and both feet’s black spots .
-Patient was diagnosed with Addison disease on march2018 ,then after 6 month was diagnose with hypothyroidism .
-No hx of seizures ,confusion ,-ve icu admissions .
-Pt was on prednisolone 15 mg od daily as hydrocortisone not available in hospital since
+ve hx of upper respiratory tract infection 1 week ago.
PE
-patient conscious oriented vitals stable BP 120/90 afebrile GCS 15/15 not pale not jaundice, Dark spots at left eye conjunctive and bronze face
-Neck : no neck mass , Hand :no pigmentation normal capillary refill no muscle wasting.
-Chest: EBAE no wheeze . -CNS :intact. -Jvp :not elevated
-Abdomen: soft Lax Nad. -LL :no edema. - CVS s1+s2+0
Have multiple .5 cm width red Steria lower abdomen and shoulders and chest ,hips behind knees since 6 weeks .

2. -ve surgical history
-ve drug allergy
-ve family history
-Non smoker
Pt labs on admission 24/10/2019 was:
WBC 15.6. HGB. 13.2. PLT. 495. Creatinine 82 URIN NA:11
NA104. K4.9. Urea10. Ast34
Total bil 17. Direct bil 3.2. LDL 3.6. Cholesterol 5.7
T3. 5.31. T4. 24.5. TSH. 4.7 serum cortisol 0.6 at 9/4/2019
Hospital course:
1-Pt was given Hydrocortisone Iv 100 mg stat
2-Pt shifted From PRDENSIOLON TO hydrocortisone 10mg Am and 5mg 7Pm for 1 day
THEN Hydrocortisone 20mg am ,10mg pm .
3-IV fluid 63cc/hr NS FOR 1 DAY ,THEN 34cc/hr NS for 1 DAY then discontinued
Discharge labs 29/10/19 :
WBC 9.5. HGB. 12. PLT. 432. Pt. 11
APTT 27.6. INR .9 NA. 121. K5
Creatinine 52 Bun 4.3
24/10 105
25/10 115
26/10 118
27/10 118
28/10 119
29/10 121
NA level

3. Addison

4. Primary adrenal insufficiency (ADDISON)
inability of adrenals to produce sufficient hormones (CORTISOL ,ALDOSTERON,ANDROGEN)
Causes:
1-30–40% Isolated autoimmune adrenalitis
2-60–70% as part of autoimmune polyglandular syndromes (APS)
APS1: associated with Hypoparathyroidism, chronic mucocutaneous candida occurs in young
APS2 associated with Hypothyroidism, hyperthyroidism, premature ovarian failure, vitiligo, type 1 diabetes mellitus, pernicious anemia ,celiac
disease usually occurs at adult hood
3-congenital adrenal hyperplasia
4-Infection TB HIV CMV / infiltration/ Adrenal metastases/ hemorrhage trauma
Secondary adrenal insufficiency
is the consequence of dysfunction of the hypothalamic-pituitary component majority of cases are caused by:
1-Pituitary (tumors ,irradiation, apoplexy/hemorrhage, infiltration)
2-Drug-induced (rifampicin, phenytoin by increasing steroid metabolism ,ketoconazole(inhibit synthase of steroid) , opiate
,anticoagulant,chronic steroid use.

6. DIAGNOSIS

7. MANAGEMENT
-HYDROCORTISON 20-30 mg/day with meals( 2/3 of dose at morning 1/3 dose at evening.)
Dose reduces with patient or DM,HTN, Dose increased with anti convulsant
-Mineral replacement by Fludrocortisone .05-.1 Po od
-Intake of NA 3-4gm /d
The adequacy of mineral corticoid therapy can be assessed by a measurement electrolytes and BP ,RBS as low cortisol cause hypoglycemia
Drug potency:
Each 1 mg of prednisolone =4 mg hydrocortisone
Each 1mg methyl prednisolone=20 mg hydrocortisone
-Complication of medication:
Glucocorticoid :gastritis
Minerals :Hypokalemia HTN ,CHF Cardiomegaly
Instruction to patient :
-The dose should be double in face of any stressors (sick day )or pre any surgery or dental extraction adjusted by patient in home.
-Yearly Bp ,U/E clinic follow up
Prognosis:
13 years less in male estimated life expectancy ,and 3 yrs in female .death can cause from Addison crisis due uncompliated to medication or
infection .

8. Thank you