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EMERGENCY MEDICINE FULL 4kurs.doc
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Symptoms

The symptoms of Addison's disease develop insidiously, and it may take some time to be recognised. The most common symptoms are fatigue, muscle weakness, vomiting, diarrhoea, headache, sweating, changes in mood and personality and joint and muscle pains. Some have marked cravings for salty foods due to the urinary losses of sodium.[1]

Clinical signs

On examination, the following may be noticed:[1]

  • Low blood pressure that falls further when standing (orthostatic hypotension)

  • Darkening (hyperpigmentation) of the skin, including areas not exposed to the sun; characteristic sites are skin creases (e.g. of the hands) and the inside of the cheek (buccal mucosa).

  • Signs of conditions that often occur together with Addison's: goitre and vitiligo

Addisonian crisis

An "Addisonian crisis" is a constellation of symptoms that indicate severe adrenal insufficiency. This may be the result of either previously undiagnosed Addison's disease, a disease process suddenly affecting adrenal function (such as adrenal haemorrhage, or in a patient with known Addison's disease who has suffered an intercurrent problem (e.g. infection, trauma). Additionally, this situation may develop in those on long-term oral glucocorticoids who have suddenly ceased taking their medication.

Untreated, an Addisonian crisis can be fatal. It is a medical emergency, usually requiring hospitalization. Characteristic symptoms are:[citation needed]

  • Sudden penetrating pain in the legs, lower back or abdomen

  • Severe vomiting and diarrhea, resulting in dehydration

  • Low blood pressure

  • Loss of consciousness/Syncope

  • Hypoglycemia

  • Confusion, psychosis

  • Convulsions

Diagnosis

Features suggesting diagnosis

Routine investigations may show:[1]

  • Hypoglycemia, low blood sugar (worse in children)

  • Hyponatraemia (low blood sodium levels)

  • Hyperkalemia (raised blood potassium levels), due to loss of production of the hormone aldosterone

  • Eosinophilia and lymphocytosis (increased number of eosinophils or lymphocytes, two types of white blood cells)

Treatment

Maintenance treatment

Treatment for Addison's disease involves replacing the missing cortisol (usually in the form of hydrocortisone tablets) in a dosing regimen that mimics the physiological concentrations of cortisol. Treatment must usually be continued for life. In addition, many patients require fludrocortisone as replacement for the missing aldosterone. Caution must be exercised when the person with Addison's disease becomes unwell, has surgery or becomes pregnant. Medication may need to be increased during times of stress, infection, or injury.

Addisonian crisis

Treatment for an acute attack, an Addisonian crisis, usually involves intravenous (into blood veins) injections of:

  • Cortisone (cortisol)

  • Saline solution (basically a salt water, same clear IV bag as used to treat dehydration)

  • Glucose

Hyperaldosteronism,

also aldosteronism, is a medical condition where too much aldosterone is produced by the adrenal glands, which can lead to lowered levels of potassium in blood.

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