Addison's Disease

Primary adrenal cortical insufficiency - not enough steroid hormones cortisol and aldosterone. Cortisol in the main issue

• Autoimmune is most common form

Triad of hyperpigmentation, postural hypotension and hyponatraemia

ACTH excess → increased melanin production → bronze appearance (hyperpigmentation) 

Diagnosis via short synactin test (stimulation of cortisol)

Management

Cortisol replacement: Treatment with hydrocortosone (20-30mg) divided doses, with the majority of the dose given in the morning. Double dose in times of stress

Aldosterone replacement: flurocortisone