1. Addison’s Disease

2. Addison’s disease Prevalence: 1 in 125,000 First described by Dr Thomas Addison who documented cases caused by tuberculosis. Most common cause now autoimmune in the UK but remains TB worldwide Autoimmune Addison’s usually occurs between age 20- 50

3. JFK suffered from both Addison’s and hypothyroidism

4. Symptoms Fatigue/weakness Pigmentation of skin (sun-exposed areas, armpits, nipples, palmar creases, inside mouth, recent scars, pressure points e.g elbows) Dizziness (from hypotension) Decreased appetite & weight loss Occasional nausea & vomiting, abdominal pains Occasional diarrhoea/constipation Muscle cramps/pain Vitiligo Cravings for salty food or drink Oligomenorrhoea/amenorrhoea in women Depression/psychosis/low self-esteem The unforgiving master of non-specificity and disguise

5. Consider JFK – - Presented with two episodes of collapse secondary to hypotension as a child - Frequent episodes of abdominal pain and recurrent diarrhoea - Inability to gain weight for much of his life - Diagnosed aged 30 with Addison’s

6. On examination Look for cutaneous and mucosal hyperpigmentation Check blood pressure Look for evidence of other autoimmune disease

7. Investigations FBC, U&Es, LFTs, glucose, calcium Venous blood gas (may show normal anion gap metabolic acidosis) Short synacthen test

8. Management Will depend on the aetiology but typically includes glucocorticoids (hydrocortisone) +/- mineralocorticoid (fludrocortisone) replacement

9. Follow-up Patient should wear Medic Alert bracelet Carry steroid card with them Must ↑ steroids for stenuous activity/illness/injury/stress Warn patient against abruptly stopping steroids Should have 100mg injectable hydrocortisone at home in case of vomiting Patients must be followed up yearly for BP & U+E checks

10. Addisonian crisis Patient may present with; Hypotension Severe vomiting and diarrhoea Pains in the back and abdomen Dehydration Collapse (triggered by stresses such as infection/ trauma/ surgery/ insufficient hydrocortisone for strenuous activity)