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Addison Disease

Sara Bakhtiar, MBBS and Sahil Mullick, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Primary adrenal gland insufficiency, which results from partial or complete (>90%) destruction of the adrenal cells with inadequate secretion of glucocorticoids and mineralocortic...

DIAGNOSIS

HISTORY

  • Weakness, fatigue

  • Anorexia, nausea, vomiting

  • Abdominal pain

  • Chronic diarrhea

  • Depression (60–80% of patients)

  • Decreased cold tolerance

  • Salt craving

  • Myalgia, flaccid muscle paralysis (hyperkal...

TREATMENT

GENERAL MEASURES

Consider the 5 S’s for the management of adrenal crisis: 
  • Salt, sugar, steroids, support, and search for a precipitating illness (usually infection, trauma, recent surgery, or...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Monitor BP, electrolytes, plasma renin, and fasting blood glucose level.

  • Periodically evaluate for long-term complications of corticosteroid use; screen for osteop...

REFERENCES

1
Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab.  2016;101(...

SEE ALSO

Algorithm: Adrenocortical Insufficiency 

CODES

ICD10

  • E27.1 Primary adrenocortical insufficiency

  • A18.7 Tuberculosis of adrenal glands

  • E27.2 Addisonian crisis

ICD9

  • 255.41 Glucocorticoid deficiency

  • 017.60 Tuberculosis of adrenal glands, unspecified

SNOMED

CLINICAL PEARLS

  • 80% of cases are caused by an autoimmune process; the average age of diagnosis in adults is 40 years.

  • Consider the 5 S’s for the management of Addison disease: salt, sugar, steroids, su...

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