Addison Disease in MRCP (2)

Addison Disease in MRCP (2)

I strong believe that Addison Disease is a difficult diagnosis to make in clinical medicine. Anyway, there are a few points to remember if you are sitting for your MRCP,

1) The commonest cause of Addison disease is autoimmune in origin ( about 70%). Antibodies to 21-hydroxylase are commonly found.

2) There is long list of other causes, however, always remeber that it may be associated with infection ( especially tuberculosis) and autoimune polyglandular deficiency, therefore always look for other endocrine deficiency if you pick up Addison disease in a patient.

3) I think the common scenario they give you in your MRCP is a patient with chronic fatigue ( sometimes chronic diarrhoe) with the following abnormalities,

a) hyponatremia and hyperkalemia ( I hope you know the reason behind this!)
b) hypoglycemia
c) hypotension
d) pigmentation ( remember your ACTH??)- look at mucosal and palmar creases. A popular MRCP PACES short case!!

( Picture source:pathmicro.med.sc.edu)


It is easy to make a diagnosis, your adrenal should secrets cortisol if stimulated by ACTH, therefore, if your body fails to secrets cortisol to a certain level after ACTH ( synacthen test), that it means you have adrenal insufficiency ( Addison disease)


About the treatment, of course if patient comes in with crisis, treat accordingly and later put patient glucocorticoid therapy and if possible find out the underlying cause!