Clinical Skills Pearl Vol 2 (#17): Adrenal Insufficiency Part 2

Part 2.....how much of the adrenal gland needs to be destroyed for you to become Addisonian? Here's a dandy...what happens to the following blood tests..Na, Cl, Bicarb, K, Urea, Glucose,LFTs, Ca,Hb, WBC diff,

BONUS TIME>>>>test to distinguish primary from secondary Addison disease?

Pathogenesis:
Addison disease is characterized by progressive destruction of the adrenal glands. This is usually autoimmune based and most likely the result of cytotoxic T lymphocytes, although 50% of patients have circulating adrenal antibodies. Clinical and biochemical insufficiency only occurs once >90% of the gland is destructed.

In the early period of adrenal insufficiency, investigations may be normal however, patients have no reserve when faced with stress.

Laboratory abnormalities in adrenal insufficiency:
Sodium - reduced
Chloride - reduced
Bicarbonate - reduced
Potassium - increased
Uraemia
Hypoglycaemia
Abnormal liver function tests
Calcium - increased in 10-20%
Normocytic anaemia
Lymphocytosis
Moderate eosinophilia

Distinguish between primary and secondary insufficiency by measuring the ACTH level
Primary insufficiency - ACTH increased; Secondary insufficiency - ACTH decreased.

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

Posted on behalf of Dr. M. Luterman