SECOND YEAR

PBL
BIOCHEMISTRY
ENDOCRINOLOGY
ADDISON’S DISEASE

DR MADIHA SOBAN
KIMS
A 63-year-old woman presented with increase in
darkening of the skin, dizziness, easy fatigability,
occasional vomiting and progressive weight loss since
eight months. There were no headaches, blurred vision,
and neither loss of consciousness nor change in her
bowel habit. The medical history and systemic review
revealed no abnormality. Vitals showed pulse of 106
bpm, blood pressure 100/60 mm of Hg. A computerized
tomography scan (CT) of the abdomen showed a non-
enhancing oval shaped left suprarenal mass with
calcification suggestive of adrenal tuberculosis, she was
commenced on anti-tuberculosis drugs.
 Her lab investigations showed the following results:

Haemoglobin=10gm/dl, with normal red cell morphology;

ESR=58mm/hr(Westergreenmethod);

Fastingbloodsugar=76mg/dl

Total serum protein = 7.8g/L (albumin-3.4g/L and globulin

4.4g/L).

Plasma cortisol was undetectable at 0 and 30 minutes of

cosyntropin administration (0.25 mg).

Plasma rennin and aldosterone activity could not be

estimated.
 INTRODUCTION

 There are 2 adrenal glands.

 4 grams each.
 At the superior pole of the 2 kidneys.
 Each gland is composed of 2 distinct parts:

1. Adrenal Cortex
2. Adrenal Medulla
Synthesis and Secretion of Adrenocortical
Hormones
Abnormalities in
Adrenocortical
Secretion
 Abnormalities in Adrenocortical
Secretion
Hypoadrenalism-Addison’s Disease

Failure of the adrenal cortices to produce adrenocortical hormones; most

frequently caused by primary atrophy of the adrenal cortices

 This atrophy is caused by:

1. 80% by autoimmunity against the cortices.
2. Tuberculous destruction of the adrenal glands.
3. Invasion of the adrenal cortices by cancer.

 The disturbances in Addison’s disease are:

1. Mineralocorticoid Deficiency
2. Glucocorticoid Deficiency
3. Melanin pigmentation
 Abnormalities in Adrenocortical Secretion

Mineralocorticoid Deficiency

• Lack of aldosterone secretion Na+

reabsorption ,water lost into urine extracellular
fluid volume.

• Hyponatremia, hyperkalemia and mild acidosis.

 Extracellular fluid volume depleted, plasma volume falls, red blood cell
concentration rises markedly, cardiac output decreases and the patient dies
in shock (4 days – 2 weeks)
 Abnormalities in Adrenocortical Secretion

Glucocorticoid Deficiency

 Unable to maintain normal blood glucose concentration between meals (no

gluconeogenesis)

• Many of the metabolic functions of the body will be depressed (no mobilization
of fats and proteins form the tissues)

• Muscles are weak .

• Susceptibility to deteriorating effects of different types of stress.

 Abnormalities in Adrenocortical Secretion

Treatment
A person can live to years if small quantities of mineralocorticoids and glucocorticoids
are administered daily.

Addisonian Crisis : the critical need for extra glucocorticoids and the associated
severe debility in times of stress.

Different types of trauma, disease or other stresses, such as surgical operations, a person is
likely to have an acute need for excessive amounts of glucocorticoids and often must be given
10 or more times the normal quantities to prevent death
Abnormalities in Adrenocortical Secretion
 Abnormalities in Adrenocortical Secretion

Symptoms

Addison's disease symptoms usually develop slowly, often over several months,
and may include:

•Muscle weakness and fatigue

•Weight loss and decreased appetite
•Darkening of your skin (hyperpigmentation)
•Low blood pressure, even fainting
•Salt craving
•Low blood sugar (hypoglycemia)
•Nausea, diarrhea or vomiting
•Muscle or joint pains
•Irritability
•Depression
•Body hair loss
 Abnormalities in Adrenocortical Secretion

Acute adrenal failure (addisonian crisis)

Sometimes, the signs and symptoms of Addison's disease may appear suddenly.
In acute adrenal failure (addisonian crisis),

The signs and symptoms may also include:

•Pain in your lower back, abdomen or legs

•Severe vomiting and diarrhea, leading to dehydration
•Low blood pressure
•Loss of consciousness
•High potassium (hyperkalemia)
Abnormalities in Adrenocortical Secretion

 United States President John

F. Kennedy was one of the
best-known people with
Addison's disease and was
possibly one of the first to
survive major surgery.
Substantial secrecy
surrounded his health during
his years as president.