Emergency Care: Addisonian Crisis and Adrenal Insufficiency

Posted by e-Medical PPT Thursday, September 30, 2010
Addison’s disease is a rare endocrine disorder where in the adrenal glands produce insufficient glucocorticoids and mineralocorticoids.The symptoms of Addison's disease develop insidiously, and it may take some time to be recognized. The most common symptoms are fatigue, lightheadedness upon standing or while upright, muscle weakness, fever, weight loss, difficulty in standing up, anxiety, nausea, vomiting, diarrhea, headache, sweating, changes in mood and personality, and joint and muscle pains. Some have marked cravings for salt or salty foods due to the urinary losses of sodium.Affected individuals may have hyper pigmented skin.This occurs because melanocyte-stimulating hormone (MSH) and adrenocorticotropic hormone (ACTH) share the same precursor molecule, Pro-opiomelanocortin (POMC). After production in anterior pituitary gland, POMC gets cleaved into Gamma-MSH, ACTH and Beta-lipotropin. The subunit ACTH undergoes further cleavage to produce Alpha-MSH, the most important MSH for skin pigmentation.
Addisonian crisis is a collection of symptoms that indicate severe adrenal insufficiency. This may be the result of either previously undiagnosed Addison's disease, a disease process suddenly affecting adrenal function (such as adrenal hemorrhage),infection or trauma, in the setting of known Addison's disease.Addisonian crisis can be fatal. It is a medical emergency, usually requiring hospitalization. Additionally, this situation may develop in those on long-term oral glucocorticoids who have suddenly ceased taking their medication.In these people, long term use of synthetic glucocorticoids will have caused further atrophy of the adrenal glands by negative feedback. It is also a concern in the setting of myxedema coma; thyroxine given in that setting without glucocorticoids may precipitate a crisis.

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