ADDISON’S

DISEASE
GROUP 5
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TOPICS
Case review
Etiology of Addison’s disease
Pathogenesis of Addison’s disease
Sign&symptoms of Addison’s disease
Pathophysiology of Addison’s disease
Diagnosis of Addison’s disease
Treatment of Addison’s disease
Proagnosis of Addison’s disease
01
SUMMARY OF
THIS CASE
PATIENT PROFILE
A 20-YEAR-OLD FEMALE PATIENT

CHIEF COMPLAINT
Vomiting with some fresh blood
Weight loss from 50 kg. in August to 41 Kg.

PRESENT ILLNESS
3 month 4 month later Today (next 6 month)
She was admitted with Vomiting with some fresh She was readmitted with
history of persistent blood due to Mallory - a Addison's crisis due to
vomoting between 5 Weiss tear. poor compliance.
and 15 times a day . Ongoing weight loss from
Weight loss 50 kg. in August to 41 Kg.
and ongoing lethargy.
Right-sided abdominal pain
PAST HISTORY
She was treated as ongoing gastritis with vomiting.
This was t reated with intravenous fluids and she was
subsequently discharged on anti-emetics.

FAMILY HISTORY
The patient was unsure about any relevant family
history.
PERSONAL AND SOCIAL HISTORY
She was a social smoker and denied any alcohol
intake.
LAB INVESTIGATION
Sodium levels 129 mmol/L (normal 133–146 mmol/L)
potassium levels 4.9 mmol/L (3.4–5.3 mmol/L),
C reactive protein (CRP) 16 (<5),
Hemoglobin 12.4 g/dL (12.5–16 g/dL),
White cell count (WCC) 11.6 (4–11×109/L)
She had a mild eosinophilia.
Given the history and findings a random cortisol was
at 2 nmol/L (102–535 nmol/L).
Liver and renal function tests were normal.
Thyroid stimulating hormone (TSH) was 33 mU/L
(0.27–4.2 mU/L)
And blood glucose was 4.5 mmol/L (4–6 mmol/L).
 DIFFERENTIAL DIAGNOSIS
On the basis of the history and investigation results,
the patient was diagnosed with Addison’s
disease.
Given her history of hypothyroidism, Addison’s disease and positive
gastric parietal cell antibodies;
the possibility of autoimmune polyendocrine syndrome was
raised.
 02
ETIOLOGY
caused by damage to the adrenal
glands. Results in too little of the
hormone cortisol and aldosterone.
 PRIMARY ADRENAL
01 INSUFFICIENCY
Adrenal cortex is damaged
Autoimmune disease
Tuberculosis
Infections of adrenal glands
Spread of cancer to adrenal glands
Bleeding into the adrenal glands

SECONDARY ADRENAL
02 INSUFFICIENCY
Decrease Adrenocorticotropic hormones (ATCH) caused by
Pituitary tumors
Inflammation of Pituitary gland
Pituitary surgery
Temorary causes by HTTPS://WWW.YOURHORMONES.INFO/HORMONES/CORTISOL/

Take corticosteroids (prednisone)

-> treat asthma or arthritis
03 PATHOGENESIS

HTTPS://LINK.SPRINGER.COM/CHAPTER/10.1007/978-981-19-4800-8_7
 04 SIGN & SYMPTOMS

SYMPTOMS
SIGN
fatigue (lack of energy or
Hyperpigmentation Bronze
motivation)
of skin area
(Except 2nd adrenal insufficiency) muscle weakness
Hair loss low mood
vitiligo loss of appetite and
unintentional weight loss
increased thirst
 05
PATHO
PHYSIO
LOGY

https://calgaryguide.ucalgary.ca/primary-adrenal-insufficiency-clinical-findings/
 PATHOPHYSIOLOGY
05

https://sci-hub.se/10.1038/s41572-021-00252-7
05 PATHOPHYSIOLOGY

https://pubmed.ncbi.nlm.nih.gov/36902007/
06 DIAGNOSIS
History taking Physical examination
Nausea Hyperpigmentation
Vomiting Dehydrated
Diarrhea Weakness
06 D I A G N O S I S
Lab investigation
1.Blood test
High : potassium, level of adrenocorticotrophic hormone (ACTH)
Low : sodium, cortisol level, level of the hormone aldosterone,
level of glucose
Positive adrenal antibodies

2.Synacthen stimulation test

If the ACTH level is high but the cortisol and aldosterone levels are
low, it's usually confirmation of Addison's disease.
06 D I A G N O S I S
3.Thyroid function test
People with Addison's disease often have an underactive thyroid
(hypothyroidism)
By testing the levels of certain hormones in your blood

4.Scan
CT scan checks the size of the adrenal glands
MRI of the pituitary gland
07 T R E A T M E N T
1.Glucocorticoid replacement regimen
Hydrocortisone (15–25 mg) or cortisone acetate (20–35 mg) in
two or three divided oral doses per day
Prednisolone (3–5 mg/d), administered orally once or twice daily

2. Mineralocorticoid replacement
Fludrocortisone (starting dose, 50–100 μg in adults) and not
restrict their salt intake

3. Dehydroepiandrosterone replacement
08 P R O G N O S I S
Patients with Addison disease are at increased
risk of developing other autoimmune
conditions; up to 50% of patients with
Addison disease may develop another
autoimmune condition.
09
REFERENCES
 REFENRENCS
Addison’s disease. (n.d.). NHS Inform. https://www.nhsinform.scot/illnesses-and-
conditions/glands/addisons-disease
Addison’s disease - Symptoms and causes - Mayo Clinic. (2022, December 8). Mayo
Clinic. https://www.mayoclinic.org/diseases-conditions/addisons
disease/symptoms-causes/syc-20350293
UpToDate. (n.d.). UpToDate. https://www.uptodate.com/contents/pathogenesis-of-
autoimmune-adrenal-insufficiency#H1
Hahner, S., Ross, R., Arlt, W., Bancos, I., Burger-Stritt, S., Torpy, D. J., Husebye, E. S.,
& Quinkler, M. (2021a). Adrenal insufficiency. Nature Reviews Disease Primers,
7(1). https://doi.org/10.1038/s41572-021-00252-7
Sgaggi, S., & Sgaggi, S. (2021a). Primary Adrenal Insufficiency: Clinical findings |
Calgary Guide. The Calgary Guide to Understanding Disease.
https://calgaryguide.ucalgary.ca/primary-adrenal-insufficiency-clinical-findings/
https://pubmed.ncbi.nlm.nih.gov/36902007/
THANK YOU!