Addison`s Disease

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Addison's disease laand
nc adrenal
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insufficiency al A
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Gill Cash mother of Adam
Cash
Matt Ward MCPara
Head of Clinical Practice
Objectives
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l will be able to:
• That by the end of this sessionCyou
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– Define Addison’s disease
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a of Addison’s
– Describe the causes
disease and the signs and
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symptoms
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– Describe the Addisonian
crisis
and
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emergency management
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Addison’s disease
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ethere is failure
• Addison’s disease occurs
when
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of the adrenalnaglands
to yproduce
enough of a
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hormoneNcalled
cortisol
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Causes of Addison’s disease
•
•
•
•
•
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Auto immune disease 90%
• eInfiltration
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Tuberculosis <10%
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Surgical removal
•
Schilder’s
disease (adreanal
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luekodystrophy)
Haemorrhage/infarction
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N septicaemia
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Meningococcal
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Incidence and prevalence
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• Addison’s is a rare condition
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• It has an incidencel Aof 4-5 perCmillion
per year and a
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prevalence of
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t 40-60 peramillion
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Signs and symptoms of Addison’s disease
• Symptoms
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–
–
–
–
–
–
Weight loss
Anorexia
Weakness
Depression
Diarrhoea
Abdo pain
Myalgia
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• Signs
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e – Pigmentation, especially
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- Nausea/vomiting
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of new scars and creases
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- Malaise
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– Buccal pigmentation
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Fever
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– Postural hypotension
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- Confusion
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– Loss of weight
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- Syncope
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– General wasting
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– Dehydration
& - Constipation
– Loss of body hair
– Hypoglycaemia
Adams’ Story
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What is an Addisonian Crisis?
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• An Addisonian crisis or adrenal
insufficiency
occurs
when the
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uenough cortisol
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body can no longer produce
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f by the adrenal glands when
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• Cortisol is a hormone
produced
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the body is under stress
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• Addison’s crisis is a time critical medical emergency
Who is at risk of Addisonian Crisis?
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• Those most at risk for Addisonian crisis
l are:
C
cedisease
– individuals suffering from Addison’s
e
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l pituitary gland,
e where adrenal
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– people who have damage to
the
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insufficiency may be al A
result
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a for any kindtyof adrenal insufficiency and who do
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– patients being treated
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not take their
N medication t S
n some kinds4 of physical trauma and stress
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– people who are experiencing
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– surgical patients
&
– individuals who are experiencing dehydration
Signs and symptoms of an Addisonian crisis
• Symptoms
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–
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–
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• Signs
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e – Hypotension
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f
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Nausea/vomiting - Myalgia
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– Dehydration
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Weakness
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– Hypoglycaemia
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Confusion N
- Malaise S
– Tachycardia/bradycardia
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Diarrhoea
- Syncope
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– Hypothermia
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1
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Abdominal pain & P
- Constipation 2
Management
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• Start correcting any ABCD problems.
e Cnearest appropriate
• Undertake a TIME CRITICAL transfer tocthe
receiving
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hospital.
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• Continue patient management
en-route.
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a call ty
• Provide an alert/information
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• Administer hydrocortisone
to: S
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– Patients in an established
adrenal crisis.
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– Steroid-dependent
& patients who have become unwell to prevent them
having an adrenal crisis
If in doubt, it is better to administer hydrocortisone.
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Questions?
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Summary
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• Addisonian crisis/adrenal insufficiency
l is a medical emergency
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cewith vaguecesymptoms but
• Have a high suspicion for patients
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significant hypotension m
ofbunknown origin
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• If unsure of the diagnosis
still give
hydrocortisone as soon as
a
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possible
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Thank you
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