Monday, 2 June 2008

Addison's disease

there is generalized pegmentation,most marked in scars,skin crease and buccal mucosa.

examin the abdomen for adrenal scar(Nelson syndrome)
check the BP lying and standing

how would you confirm the diagnosis?
Random cortisol
Short synacthin test (normal cortisol rise above 600 nmol/l or increase by 300 nmol/l)
ACTH level or long synacthin test

what is the most common cause?
mention other caues of hyperpegmentaion.
what is Schmidt's syndrome?


  1. causes of Addison's disease:
    1-80% idiopathic(autoimmune)
    4-HIV infection

  2. Short synacthin test:
    Adrenal glucocorticoid secretion is controlled by ACTH released by the anterior pituitary.
    This test evaluates the ability of the adrenal cortex to produce cortisol after stimulation by synthetic ACTH (tetracosactide; Synacthen ®).
    Adrenal insufficiency is excluded by an incremental rise in cortisol of > 200nmol/L and a 30 min value > 600 nmol/L.

  3. Autoimmune
    Schidmt syndrome- Addison disease together with hypothyroidism

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  7. Schidmt syndrome- Addison disease together with hypothyroidism and DM1