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

Date: 2015-01-12; view: 811