Deficiency of cortisol and aldosterone due to adrenal cortex destruction (autoimmune most common).

Hyperpigmentation (bronze skin) on sun-exposed areas, knuckles, palmar creases, buccal mucosa. Caused by high ACTH.

"Salt-wasting, Potassium-keeping": Hyponatremia, Hyperkalemia, Hypoglycemia, Hypercalcemia.

Low serum cortisol. High plasma ACTH if primary (Addison's), low ACTH if secondary (pituitary problem).

ACTH Stimulation Test

Definitive test. Administer ACTH; cortisol fails to rise adequately in Addison's disease.

Primary vs. Secondary

Primary: Adrenal problem (high ACTH, hyperpigmentation). Secondary: Pituitary problem (low ACTH, no hyperpigmentation).

Stress, infection, trauma, surgery, or sudden withdrawal of steroid therapy.

Profound weakness, severe hypotension, hypovolemic shock, nausea/vomiting, abdominal pain, hypoglycemia, confusion.

EMERGENCY: IV fluids (0.9% NS), IV hydrocortisone (bolus then continuous), correct hypoglycemia, vasopressors.

Lifelong treatment. Hydrocortisone (Cortef). Dose must be DOUBLED or TRIPLED during times of stress, illness, or surgery.

Lifelong treatment Fludrocortisone (Florinef). Promotes sodium retention and potassium excretion. Monitor BP and K+.

Never skip a dose. Increase steroid dose with fever, infection, or injury. Have injectable hydrocortisone at home.

Wear a medical alert bracelet stating "Adrenal Insufficiency" and "Requires Hydrocortisone in Emergency."

Liberal sodium intake, especially in hot weather or with exercise. Small, frequent meals to prevent hypoglycemia.

Watch for weight gain, edema, hypertension. Indicates steroid dose is too high.

Monitor for orthostatic hypotension and tachycardia, signs of inadequate steroid replacement or volume depletion.

Hyperkalemia Treatment

Mild: increased fludrocortisone. Severe: Kayexalate, insulin/glucose. Monitor EKG for peaked T-waves.

Associated Conditions

Higher incidence of other autoimmune diseases (thyroiditis, vitiligo, pernicious anemia).

Chronic fatigue and the need for constant medication can be burdensome. Provide resources and support groups.

"ADDISON": Asthenia (weakness), Decreased NaCl, Decreased glucose, Increased K+, Skin hyperpigmentation, Other (N/V, wt loss).

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Addison's

Question	Answer
Key Problem	Deficiency of cortisol and aldosterone due to adrenal cortex destruction (autoimmune most common).
Manifestations	Hyperpigmentation (bronze skin) on sun-exposed areas, knuckles, palmar creases, buccal mucosa. Caused by high ACTH.
Electrolytes	"Salt-wasting, Potassium-keeping": Hyponatremia, Hyperkalemia, Hypoglycemia, Hypercalcemia.
Hormones	Low serum cortisol. High plasma ACTH if primary (Addison's), low ACTH if secondary (pituitary problem).
ACTH Stimulation Test	Definitive test. Administer ACTH; cortisol fails to rise adequately in Addison's disease.
Primary vs. Secondary	Primary: Adrenal problem (high ACTH, hyperpigmentation). Secondary: Pituitary problem (low ACTH, no hyperpigmentation).
Crisis Triggers	Stress, infection, trauma, surgery, or sudden withdrawal of steroid therapy.
Crisis Symptoms	Profound weakness, severe hypotension, hypovolemic shock, nausea/vomiting, abdominal pain, hypoglycemia, confusion.
Crisis Treatment	EMERGENCY: IV fluids (0.9% NS), IV hydrocortisone (bolus then continuous), correct hypoglycemia, vasopressors.
Glucocorticoids	Lifelong treatment. Hydrocortisone (Cortef). Dose must be DOUBLED or TRIPLED during times of stress, illness, or surgery.
Mineralocorticoid	Lifelong treatment Fludrocortisone (Florinef). Promotes sodium retention and potassium excretion. Monitor BP and K+.
Sick Day Rules	Never skip a dose. Increase steroid dose with fever, infection, or injury. Have injectable hydrocortisone at home.
Critical Safety	Wear a medical alert bracelet stating "Adrenal Insufficiency" and "Requires Hydrocortisone in Emergency."
Diet	Liberal sodium intake, especially in hot weather or with exercise. Small, frequent meals to prevent hypoglycemia.
Cushing's	Watch for weight gain, edema, hypertension. Indicates steroid dose is too high.
Vital Signs	Monitor for orthostatic hypotension and tachycardia, signs of inadequate steroid replacement or volume depletion.
Hyperkalemia Treatment	Mild: increased fludrocortisone. Severe: Kayexalate, insulin/glucose. Monitor EKG for peaked T-waves.
Associated Conditions	Higher incidence of other autoimmune diseases (thyroiditis, vitiligo, pernicious anemia).
Psychosocial Support	Chronic fatigue and the need for constant medication can be burdensome. Provide resources and support groups.
Mnemonic	"ADDISON": Asthenia (weakness), Decreased NaCl, Decreased glucose, Increased K+, Skin hyperpigmentation, Other (N/V, wt loss).

Created by: Wasurenboh

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