ADDISONS DISEASE

Symptoms disease have a slow development and may become established before recognition.

Most common:

• Fatigue; lightheadedness upon standing or difficulty standing;muscle weakness; fever; weight loss; anxiety; nausea; vomiting; diarrhea; headache; sweating; changes in mood or personality; and joint and muscle pains.

Other manifestations:

• Salt or salty food craving casued by sodium loss through urination.
• Hyperpigmentation of the skin, as well as darkening of the palmar crease, sites of friction, recent scars, vermilion border of the lips, and genital skin.

On Physical examination:

• Low blood pressure with or without orthostatic hypotension (blood pressure that decreases with standing).

Associated with the development of other autoimmune diseases:

• Type I diabetes, thyroid disease (Hashimoto’s thyroiditis), and vitiligo.
• Presence of Addison’s in addition to any of the above conditions is called autoimmune polyendocrine syndrome.

DIAGNOSIS

• Physician may do/request:
  • History & Physical Exam
  • Routine laboratory investigations may show:
    • Hypercalcemia
    • Hypoglycemia, low blood sugar (worse in children)
    • Hyponatremia (low blood sodium levels)
    • Hyperkalemia (raised blood potassium levels)
    • Eosinophilia and lymphocytosis (increased number of eosinophils or lymphocytes, two types of white blood cells)
    • Metabolic acidosis (increased blood acidity)

RECOMMENDED MEDICATION

• Cortisol replacement (Usually lifelong treatment)
  • Hydrocortisone or Prednisone tablets
  • Prednisolone may also be used
  • Many patients may also require fludrocortisone

ADDITIONAL RECOMMENDATIONS

• Carry information on one’s person (e.g. information card) for the use of emergency medical services personnel who might respond to their needs.
• A needle, syringe, and injectable form of cortisol be carried for emergencies.
• Increase one’s medication during these situations: illness, surgery or dental treatment.
• Immediate medical attention is needed when severe infections, vomiting, or diarrhea occur, as these conditions can precipitate an Addisonian crisis.
  • If vomiting, patient may require injections of hydrocortisone instead.