Addison's disease history and symptoms: Difference between revisions

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{{Addison's disease}}
{{Addison's disease}}
{{CMG}} ; {{AE}} {{ADG}}
==Overview==
Addison's disease often has an insidious onset. In many cases, the disease is only recognized when the patient presents with an acute crisis precipitated by a stressful [[illness]] or situation. Acute adrenal insufficiency should be considered in patients presenting with [[abdominal pain]], [[nausea]], [[diarrhea]], [[hypotension]], and [[fever]]. A detailed and thorough history is necessary. Specific areas of focus when obtaining a history from the patient of Addison's disease include recent changes in diet, any signs of [[postural hypotension]] and history of [[cancer]] or other autoimmune diseases, [[tuberculosis]] or any exposure to anyone who has been diagnosed with [[tuberculosis]].


{{CMG}}
==History==
A detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient of Addison's disease include:<ref name="pmid22907517">{{cite journal |vauthors=Quinkler M |title=[Addison's disease] |language=German |journal=Med Klin Intensivmed Notfmed |volume=107 |issue=6 |pages=454–9 |year=2012 |pmid=22907517 |doi=10.1007/s00063-012-0112-3 |url=}}</ref>
*Recent changes in diet
**Patients with Addison disease often crave salty foods and are often [[Anorexia|anorexic]]
*Irregular [[menstruation]]
**[[Oligomenorrhea]] or [[amenorrhea]] are features of Addison disease
*Any signs of [[postural hypotension]]
*Any recent changes in [[weight]]
*History of [[tuberculosis]] or any exposure to someone with [[tuberculosis]]
*History of [[malignancy]]
*History of other [[autoimmune disease]], such as [[Graves' disease|Graves disease]], [[Hashimoto's thyroiditis]], [[hypoparathyroidism]], [[vitiligo]], [[pernicious anemia]] or [[diabetes mellitus]]
*[[Family history]] of Addison's disease or any other [[Adrenal gland|adrenal]] disorder


==History and Symptoms==
==Symptoms==
===Symptoms===
Addison's disease often has an insidious onset. In many cases the disease is only recognized when the patient presents with an acute crisis precipitated by a stressful illness. Acute adrenal insufficiency should be considered in patients presenting with [[abdominal pain]], [[nausea]], [[diarrhea]], [[hypotension]] and [[fever]].<ref name="pmid23633816">{{cite journal |vauthors=Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S |title=Addison's disease |journal=Contemp Clin Dent |volume=3 |issue=4 |pages=484–6 |year=2012 |pmid=23633816 |pmc=3636818 |doi=10.4103/0976-237X.107450 |url=}}</ref><ref name="pmid12788587">{{cite journal |vauthors=Arlt W, Allolio B |title=Adrenal insufficiency |journal=Lancet |volume=361 |issue=9372 |pages=1881–93 |year=2003 |pmid=12788587 |doi=10.1016/S0140-6736(03)13492-7 |url=}}</ref>
The symptoms of adrenal insufficiency develop insidiously, usually begin gradually, and they may take some time to be recognized. Some have marked cravings for salty foods due to the loss of [[sodium]] in the urine. Characteristics of the disease are;
===Common Symptoms===
* Chronic, worsening [[fatigue]]
*[[Weakness]]
* [[Muscle weakness]]
*[[Fatigue|Chronic fatigue]]
* [[Loss of appetite]]
*[[Weight loss]]
* [[Weight loss]]
*[[Anorexia]]
* [[Headache]]
*[[Nausea]]
* [[Sweating]]
*[[Vomiting]]
* Changes in mood and personality
*[[Diarrhea]]
About 50 percent of the time, one will notice;
*Intolerance of temperature extremes
* [[Nausea]]
*[[Abdominal pain]]
* [[Vomiting]]
*[[Amenorrhea]]  
* [[Diarrhea]]
*Craving for salty foods
* [[Dizziness]] or [[fainting]] - due to [[low blood pressure]] that falls further when standing
*[[Depression]]
 
*[[Dizziness]]
[[Addison's disease]] can cause irritability and [[depression]]. Because of salt loss, a craving for salty foods is also common. [[Hypoglycemia]], or [[low blood glucose]], is more severe in children than in adults. In women, menstrual periods may become irregular or stop.
===Symptoms of Addisonian crisis===
Because the symptoms progress slowly, they are usually ignored until a stressful event like an illness or an accident causes them to become worse. This is called an [[addisonian crisis]], or [[acute adrenal insufficiency]]. In most cases, symptoms are severe enough that patients seek medical treatment before a crisis occurs. However, in about 25 percent of patients, symptoms first appear during an addisonian crisis.
Symptoms of Addisonian crisis include:
 
*[[Dizziness]], [[generalized weakness]] ([[fatigue]])
Symptoms of an addisonian crisis include;
*[[Anorexia]]
:*
*Sharp, sudden [[pain]] in the [[abdomen]], [[legs]], or [[lower back]]
Left untreated, an addisonian crisis can be fatal.
*Severe [[vomiting]] and [[diarrhea]]
 
*[[Dehydration]]
{| class="wikitable"
*Loss of [[consciousness]]
!Type of presentation
*[[Hypoglycemia]]
!Harmone deficiency
!Common symptoms
!Less common symptoms
|-
|Acute adrenal insufficiency
|Mainly cortisol
|
* Sudden penetrating pain in the lower back, abdomen, or legs
* Severe [[vomiting]] and [[diarrhea]]
* [[Dehydration]]
* Low blood pressure - [[dizziness]] and [[fainting]]
* [[Loss of consciousness]]
|In acute adrenal hemorrhage,
* Deteriorates with sudden collapse,
* Abdominal or flank pain,
* Nausea with or without hyperpyrexia.
|-
| rowspan="2" |Chronic adrenal insufficiency
|Primary: Both glucocorticoid, mineralocorticoid
| rowspan="2" |
* Hyperpigmentation (prominent on the sun-exposed areas of the skin, extensor surfaces, knuckles, elbows, knees)
* Progressive weakness, fatigue, poor appetite, and weight loss.
* Nausea, vomiting, and occasional diarrhea.
* [[Myalgia|Muscle pains]]
* [[Arthralgia|Joint pains]]
 
| rowspan="2" |
|-
|Secondary: Glucorticoid
|}
 
 
{| class="wikitable"
!Symptoms
!Pathophysiology
!
!
|-
|Hyperpigmentation
|Stimulant effect of excess ACTH on the melanocytes to produce melanin
|
|
|-
|Dizziness with orthostasis
|
* Volume depletion, loss of the mineralocorticoid effect of aldosterone,
 
* Loss of the permissive effect of cortisol in enhancing the vasopressor effect of the catecholamines.
|
|
|-
|Myalgias and flaccid muscle paralysis
|Hyperkalemia
|
|
|-
|Amenorrhea
|Combined effect of weight loss and chronic ill health or secondary to premature autoimmune ovarian failure
|
|
|}


==References==
==References==

Latest revision as of 20:13, 11 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Addison's disease often has an insidious onset. In many cases, the disease is only recognized when the patient presents with an acute crisis precipitated by a stressful illness or situation. Acute adrenal insufficiency should be considered in patients presenting with abdominal pain, nausea, diarrhea, hypotension, and fever. A detailed and thorough history is necessary. Specific areas of focus when obtaining a history from the patient of Addison's disease include recent changes in diet, any signs of postural hypotension and history of cancer or other autoimmune diseases, tuberculosis or any exposure to anyone who has been diagnosed with tuberculosis.

History

A detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient of Addison's disease include:[1]

Symptoms

Addison's disease often has an insidious onset. In many cases the disease is only recognized when the patient presents with an acute crisis precipitated by a stressful illness. Acute adrenal insufficiency should be considered in patients presenting with abdominal pain, nausea, diarrhea, hypotension and fever.[2][3]

Common Symptoms

Symptoms of Addisonian crisis

Symptoms of Addisonian crisis include:

References

  1. ↑ Quinkler M (2012). "[Addison's disease]". Med Klin Intensivmed Notfmed (in German). 107 (6): 454–9. doi:10.1007/s00063-012-0112-3. PMID 22907517.
  2. ↑ Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S (2012). "Addison's disease". Contemp Clin Dent. 3 (4): 484–6. doi:10.4103/0976-237X.107450. PMC 3636818. PMID 23633816.
  3. ↑ Arlt W, Allolio B (2003). "Adrenal insufficiency". Lancet. 361 (9372): 1881–93. doi:10.1016/S0140-6736(03)13492-7. PMID 12788587.

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