Addison disease is commonly associated with:
Correct Answer: Autoimmune adrenalitis
Description: Ans. (A) Autoimmune adrenalitis(Ref: Harrison's Principle of Internal Medicine 20th Ed; Page No-2733)Autoimmune adrenalitis is the most common etiology of primary adrenal insufficiency.Patients with Adrenocortical carcinoma presents with features of adrenocortical hormones excess (Cushing's syndrome).Hypernephroma and medullary carcinoma of thyroid are not associated with Addison's disease.Addison's DiseaseAutoimmune Most common in world wide.TB: Most common in India.It occurs due to sudden stoppage of steroids. (Addisonian Crisis).Clinical Sign:AnorexiaPolyuria: > 3L/24 hrsWeight loss, FatigueWeakness with hypotensionLoss of pubic/axillary hair.Thin patient with hyperpigmented skinLaboratory abnormalities:Hyponatremia (Normal Value: 135-145 mEq).Hyperkalemia (Normal Valve: 3.5-5.5 mEq) with a mild metabolic acidosis from the inability to excrete either H+ or K+ because of the loss of aldosterone.Hypoglycemia and neutropenia: Glucocorticoids increase glucose and white cell levels.Diagnostic TestingCosyntropin (synthetic ACTH) stimulation test: It measures the level of cortisol before and after the administration of cosyntropin.CT scan of the adrenal gland: Evidence of damage gland.Gene XPERT for MTB.TreatmentSteroid replacement is DOC in adrenal insufficiency (acute and chronic) and congenital adrenal hyperplasia. Hydrocortisone is the steroid of choice in Addison's disease.The doses of steroids:#Children: 10 mg/m2/day in three dived doses#Adults: 15-30 mg/m2/day in three dived dosesDrug of Choice for Addisonian crisis: IV hydrocortisone + Fluid resuscitationPrednisone: For stable patients (non-hypotensive).Fludrocortisone: It promotes salt and water retention. It is used for patients with adrenal insufficiencies who are still hypotensive after initial replacement with prednisone.Dexamethasone: Cortisol like activity; but reduces hypoglycemic symptoms.
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