Clinical Skills Pearl Vol 2 (#16): Adrenal Insufficiency Part 1

Sent on behalf of Dr. M. Luterman

Topic is Adrenal Insufficiency.
Who was Addisson?
What is his disease?
Which is more common primary or secondary disease?
What are the symptoms?

Dr Thomas Addison was a the British physician who first described the condition in his 1855 publication On the Constitutional and Local Effects of Disease of the Suprarenal Capsules. The adjective"Addisonian" is used for features of the condition, as well as patients with Addison's disease.

Adrenal insufficiency leads to a reduction in the output of adrenal hormones i.e. glucocorticoids and/or mineralocorticoids. There are two types of adrenal insufficiency:

1) Primary insufficiency - there is an inability of the adrenal glands to produce enough steroid hormones (Addison's disease is the name given to the autoimmune cause of this insufficiency). Glucocorticoid and often mineralocorticoid hormones are lost.

2) Secondary insufficiency - there is inadequate pituitary or hypothalamic stimulation of the adrenal glands.

Epidemiology

Primary insufficiency - rare 0.8 per 100,000; affects both sexes equally and can occur at any age.

Secondary insufficiency - relatively common compared to the primary type as exogenous steroid use is frequent leading to suppression of the hypothalamic-pituitary axis.

Presentation:
Note: Advanced adrenal insufficiency is more easier to diagnose but recognition of early cases is more difficult.

Presentation in part depends on the rapidity of adrenal hypofunction Acute - e.g. Waterhouse-Friderichsen syndrome (infarction secondary to septicaemia e.g. meningococcal); presents with collapse and shock 2 Chronic - symptoms develop insidiously and may be mild.

Symptoms
Fatigue and weakness
Anorexia
Nausea
Vomiting
Weight loss
Abdominal pain
Diarrhoea
Constipation
Syncope
Dizziness
Confusion
Personality change
Irritability
Amenorrhoea
Signs
Cutaneous and mucosal pigmentation - look at mucosa and in new scars
Hypotension
Postural hypotension

http://www.patient.co.uk/showdoc/40024894/