Addison's Disease

Clinical Features:

• 1)Extreme fatigue.
• 2)Weight loss and decreased appetite.
• 3)Darkening of your skin (hyperpigmentation)
• 4)Low blood pressure, even fainting.
• 5)Salt craving.
• 6)Low blood sugar (hypoglycemia)
• 7)Nausea, diarrhea or vomiting (gastrointestinal symptoms)
• 8)Abdominal pain.

On examination: 

• 1)BP: Low, postural hypotension 
• 2)Pigmentation: In buccal mucosa, palmar crease, scars or generalized.

Investigations: 

• 1.) RBS: Low 
  
• 2.) Serum electrolytes: Hyponatremia and hyperkalemia 
• 3.) Short ACTH Stimulation test. 

Rx:

•  Tab. Cortan([post id="479" title="Prednisolone"]) 10mg ..1 +0+ 1/2 (5.00pm) — চলবে

• Tab. Aldocort(Fludrocortisonc) (0.1mg) 1+0+0......চলবে 

 Surgery: 

Minor operation:

• Inj. Hydrocortisone 100 mg IM with premedication 

Major operation: 

• Inj. Hydrocortisone 100 mg 4 times daily for 24 hours. 

Then 50 mg IM 4 times daily until ready to take tablets

Advice: 

• 1. Febrile illness: Double dose of hydrocortisone 
  
• 2). Vomiting:Parenteral hydrocortisone if unable to take it by mouth
  
• 3) Steroid card: 
  
• Patient should carry this at all times 
•  Should give informationregarding diagnosis, steroid, dose and doctor 
• 4). Bracelet and emergency pack: 
• Encourage to buy a bracelet and engrave with diagnosis, current treatment and a reference number for a central database 

Patients should be given a hydrocortisone emergency pack and trained in the self-administration of hydrocortisone 100 mg IM; they should be advised to take the pack on holidays/trips abroad.