ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Addison’s Disease: Clinical Significance Of Its Diagnosis, Course, Prognosis And Management

Updated on February 11, 2014

Sisters With Addison's Disease

Olivia was diagnosed with Addison's disease at almost 3 years old in July 2008. Little sister, Kinsley, was diagnosed with Addison's @ 7 months in Feb. 2011. We now know they were both born with it! Addison's Disease is an extremely rare disease occu
Olivia was diagnosed with Addison's disease at almost 3 years old in July 2008. Little sister, Kinsley, was diagnosed with Addison's @ 7 months in Feb. 2011. We now know they were both born with it! Addison's Disease is an extremely rare disease occu | Source

President John F Kennedy Had Addison's Disease

President John F. Kennedy had Addison’s Disease, but the Annals of Internal Medicine have determined the underlying cause of JFK’s adrenal gland insufficiency as probably a rare autoimmune disease.
President John F. Kennedy had Addison’s Disease, but the Annals of Internal Medicine have determined the underlying cause of JFK’s adrenal gland insufficiency as probably a rare autoimmune disease. | Source

Diagnosis And Prognosis

Diagnosis

Addison’s disease should be suspected clinically and confirmed by investigations. Chronic malnutrition, malabsorption states, megaloblastic anemia, tuberculosis, disseminated malignancy, vagabond’s disease, and psychiatric disorders should be considered in the differential diagnosis. Vagabond’s disease (Vagrant’s disease, vagavondia) used to be seen among beggars and uncared adolescents belonging to the lower socioeconomic groups. Pigmentation and excoriations develop in them due to pediculosis and constant scratching. Secondary hypoadrenalcorticism is part of hypopituitarism.

Course And Prognosis

Severe Addison’s disease is fatal if untreated. Death is caused by adrenal crisis occurring during periods of stress. Severe hyponatremia, shock, hypoglycemia or toxic reactions to drugs like morphine are common in them and these may prove fatal.

The prognosis has been completely changed with modern therapy. Apparent clinical and biochemical normalcy can be restored with adequate hormonal supplementation and fairly normal life with normal lifespan can be ensured.

Management Of Addison's Disease

This aim of therapy is to replace glucocorticoids and mineralocorticoids for life, with increase in dosage during periods of stress. Initially, hydrocortisone is given in a dose of 25-100 mg/day,
This aim of therapy is to replace glucocorticoids and mineralocorticoids for life, with increase in dosage during periods of stress. Initially, hydrocortisone is given in a dose of 25-100 mg/day, | Source

Management

This aim of therapy is to replace glucocorticoids and mineralocorticoids for life, with increase in dosage during periods of stress. Initially, hydrocortisone is given in a dose of 25-100 mg/day, the exact requirement is determined based on clinical and biochemical parameters. The optimum dosage required to keep the patient symptom-free with normal blood glucose and electrolyte levels is determined. A more objective method is to assess by the plasma cortisol levels after the administration of cortisol and adjusting the dose so as to give a peak morning level of 700- 800 nmols/liters and an evening level of 165 nmols/liter. The final dose has to be arrived at by trial and error since absorption and metabolism affect the drug response. Once a state of equilibrium is reached, long-term maintenance is by giving any one of the more potent preparations such as prednisolone, betamethasone or dexamethasone. Timing of the dosage is adjusted to coincide with the normal diurnal variations, i.e. the equivalent of 20 mg cortisol at breakfast and 10 mg at about 6 p.m. Peak serum levels are obtained 30- 60 minutes after oral administration and the action lasts for 6 to 8 hours.

Mineralocorticoids: In all cases with moderate or severe deficiency, mineralocorticoids have to be supplemented. Fluodrocortisone is the most potent preparation in this class and it is given in a dose of 0.05- 0.15 mg as a morning dose. Adequacy of therapy is assessed by the restoration of normal blood pressure and serum electrolytes. Side effects of overdose include hypertension, edema and hypokalemic alkalosis.

Fluodrocortisone is not freely available in developing countries such as Nigeria, Ghana, India and a large part of the South American region. Deoxycorticosterone acetate (DOCA) 2-5 mg given as intramuscular injection is a less effective, but useful substitute. Deoxycorticosterone trimethyle acetate has a longer action and an injection of 25 mg serves for 3- 4 weeks. In mild cases, simple supplementation of 8- 10g of salt in the diet helps in correcting hyponatremia and hypotension.

Symptomatic treatment includes prompt treatment of infections and associated abnormalities like diabetes and thyroid disorders. Therapy results in clinical and biochemical improvement and the patient becomes apparently normal. During periods of stress and other medical or surgical emergencies, the dose of corticosteroids should be stepped up to avoid the development of adrenal crisis. All subjects with hypoadrenalcorticism should carry identity cards giving details of the disease and the treatment schedule.

© 2014 Funom Theophilus Makama

Comments

    0 of 8192 characters used
    Post Comment

    No comments yet.

    working

    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, hubpages.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://hubpages.com/privacy-policy#gdpr

    Show Details
    Necessary
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Features
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Marketing
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Statistics
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)