| Clinical signsOn 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
Date: 2015-01-12; view: 700
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