Saunders’ Pocket Essentials of Clinical Medicine (2nd edition). Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases 2003. Adrenal insufficiency and Addison’s disease.Patients should be advised to maintain an ample intake of sodium (3-4 g/day). This is accomplished by the administration of 0.05 to 0.1mg fludrocortisone per day by mouth. Mineralocorticoid supplementation is usually needed. To simulate the normal diurnal adrenal rhythm, two-thirds of the dose is taken in the morning, and the remaining one-third is taken in the late afternoon. Patients are advised to take glucocorticoids with meals. The dose for most adults (depending on size) is 20-30mg/day. Hydrocortisone (cortisol) is the mainstay of treatment. Replacement therapy should correct both glucocorticoid and mineralocorticoid deficiencies. Patients with adrenocortical insufficiency always need specific hormone replacement therapy. A random blood sample may be stored for measurement of cortisol, and it may be appropriate to spend 30 minutes performing a short ACTH stimulation test however, investigations may need to be performed after recovery. In patients with suspected acute adrenal crisis, treatment should not be delayed pending results. Assessment of mineralocorticoids with plasma electrolyte measurements, as well as plasma renin activity and aldosterone in the supine position.Assessment of glucocorticoids with ACTH stimulation test.

In patients presenting with chronic illness, the following investigations should be performed before any treatment is commenced:

Full blood count: eosinophilia, neutropenia, lymphocytosis, anaemia.

Increased K+, Ca2+ Decreased Na+, glucose Uraemia,.

There may be vitiligo and loss of body hair in women. Postural hypotension caused by salt and water loss and hyperpigmentation are also important signs. It may also present as an emergency (Addisionian crisis), with vomiting, abdominal pain, profound weakness and hypovolaemic shock. Patient may present with lethargy, depression, anorexia and weight loss. Left untreated, Addisonian crises can be fatal. Symptoms of an Addisonian crisis include sudden penetrating pain in the lower back, abdomen, or legs severe vomiting and diarrhoea, followed by dehydration low blood pressure and loss of consciousness.

In women, menstrual periods may become irregular or stop completely. Hypoglycaemia, or low blood sugar, is more severe in children than in adults. Because of salt loss, craving of salty foods is also common. This darkening of the skin is most visible on scars skin folds pressure points, such as the elbows, knees, knuckles, and toes lips and mucous membranes.Īddison’s disease can cause irritability and depression. Skin changes also are common in Addison’s disease, with areas of hyperpigmentation, or dark tanning, covering exposed and non-exposed parts of the body.

Addison's disease symptoms