Response to Student Post: Adrenocortical Insufficiency
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Addison disease is also known as adrenocortical insufficiency is when there is a loss of adrenal cortex function causing effects in glucocorticoid and mineralocorticoid function. Some of the functions affected causes the patient to present with skin hyperpigmentation, postural hypotension and more vague symptoms can include fatigue, weight loss, nausea and vomiting and some muscle and joint pain. 80% of cases are due to autoimmune process that is caused by adrenal destruction. It can affect many individuals of all ages, but it seen in 30-50-year old and more women are affected than men. Risk factors include family history, prolong steroid use, secondary to medications being taken and infections as HIV, TB, bacterial or fungal infections.
Gold standard for assessing adrenal function includes adrenocorticotropic hormone (ACTH) measurement by injection administered of 250mcg synthetic corticotropin, cortisol will them be measured in 30-60 min after infection and if the cortisol level is <500nmol/L then there would be a diagnostic for adrenal insufficiency. Laboratory finding would show hyponatremia, hyperkalemia, and anemia (Nieman, 2020). ECG would indicate non-specified ST segment changes, EEG would present generalized slowing, TSH may be increased. All of these tests combines with the clinical presentation would give the diagnosis of Addison disease which would prompt the provider to correct the precipitating factors and then initiate pharmacologic management with glucocorticoid like hydrocortisone 15-20mg Q Daily and 10mg in the Q Evening. Calcium and Vitamin D supplementation as well (Hollier, 2021). The S approach is used for management which includes: Salt, Sugar, Steroid, Support, and Search (for precipitating illness).
References
Hollier, A. (2021). Clinical Guidelines in Primary Care (4TH ed.).
Nieman, L. K. (2020). Clinical manifestations of adrenal insufficiency in adults. UpToDate. https://www.uptodate.com/contents/clinical-manifestations-of-adrenal-insufficiency-in-adults?search=addisons%20disease%20adult&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H20