ADDISON’S DISEASE

ADDISON'S DISEASE TREATMENT

ADDISON'S DISEASE

 

Definition

It is an insidious and progressive disease condition resulting from adrenocarticol hypo function. It is characterized by increasing weakness, abnormal pigmentation of the skin and mucous membrane, weight loss, hypo function, dehydration, Gastrointestinal tract upset, occasional hypoglycaemia, stupor and coma terminating in death if un-treated "Addison's Disease Treatment"

Incidence

The occurrence is about 4 in every 100, 000 in every population of all age groups and both sexes.

 

Aetiology

Stress, trauma to the adrenal gland, Idiopathic atrophy of the adrenal gland

Destruction of the adrenal cortex by Tuberculosis infection and other forgotten infection of the lungs peritoneum, endometrium or urinary tract

Total adrenalectomy for the Reaction of Cushings syndrome, metastasis to adrenal gland from neoplasis located elsewhere such as the lungs. It may occur secondary to per hypo pitutarism.

It is in association with other endocrine disorders attributed to auto-immune mechanism e.g. hypo parthyroidism, penicious anemia, diabetes, Cirrhosis, alopasia or thyroid disorder.

 

"Addison's Disease Treatment"

 

Pathophysiology

The Pathophysiologic changes in Addison's disease depends on individual aetiological factor. findings reveal atrophy, fibrosis, infiltration or calcification of the adrenal glands. The patient looks wasted, pigmented with a small heart size. Clinical and bio chemical features resulting from deficient secretion of both adesterone or gluco cortisone

Sequel to lack of cortisone

The patient is extremely weak, unable to stand stress, hypoglycemic after fasting and has reduction in renal blood flow. There is marked low plasma Cortisone level with increase in ACTH secretion.

Pigmentation of the skin occurs due to ACTH secretion or to a concurrent increase in the secretion of melanocyte stimulating harnane (M.S.H). The poor secretion of adesterone causes increase urinary loss of sodium dehydration, hypo volamia, Hypotension, hypocalaemia or moderate rise in blood urea.

YOU CAN ALSO READ  WHAT CAUSES SEIZURE DISORDER AND SEIZURE SYMPTOMS?

 

"Addison's Disease Treatment"

 

Signs and Symptoms

The manifestations are insidious with a slow progression . Initial symptoms include- Malaise, tiredness and loss of weight, occasional amenorrhea in women, infertility in men. Increase in pigmentation of the skin and mucous membrane. Gastro Intestinal Tract disturbances such as anorexia, vomiting diarrhea and vague abdominal discomfort, hypotension, dehydration, decrease in heart size, hypo natraemia, decreased torelance to cold, decrease B.M.R, psychiatric symptoms in form of psychosis or neurosis, dizziness, Frank Syncopal Attack.

 

"Addison's Disease Treatment"

 

Diagnosis

This is based on recognition of cortisone adesterone and androgen. Deficiency Lab findings includes- Urinary estimation of ketosteroid which will be decreased low plasma cortisone levels with high ACTH level.

Abnormal serum Electrolyte level which will reveal hypo natraemia, Hypo calamia and metabolic acidosis. Inability of the patient to respond to IV infusion of ACTH.

 

"Addison's Disease Treatment"

 

Differential Changes

Salt loosing disorders like nephritis which will induce both clinical and biochemical features similar to Addison’s disease also proteinurea, casts and evidence of renal infections maybe present in salt loosing nephritis.

Other diseases that are capable of causing skin pigmentations e.g. heamocomatosis, hepatic cirrhosis, untreated hyperthyroidism, stetorea, chronic renal disease and Cushing’s syndrome.

 

"Addison's Disease Treatment"

 

Treatment

  • Replacement therapy with oral cortisone- this shows improvement in patient with a sense of well being, the dose of cortisone should be adjusted to suit the patient's age, occupation and to lesser extent the degree of adreno cortical insufficiency. The usual dosage range of cortisone is around 25 to75 mg daily in divided doses or cortisone 29 to 70 mg daily in divided doses. There maybe increase of the doses when there is supra imposed infection trauma or cytological disturbances.
  • Give mineralocorticoids to correct electrolyte imbalance and hypotension example adesterol analon-9 alpha fludrocortisone. The dose is 0.1 mg on alternate days and not exceeding 0.2mg an alternate days, check for the side effects of over dosage example weight gain, nitrogen retention, increase jugular vein pressure, oedema, headache and hypertension. Dose is determined by patient's weight, Blood pressure, Serum Urea Potassium and Sodium Levels.
  • Emphasize carrying of ID card bearing the diagnosis and current therapy by the patient. Give high protein, High CHO and vitamin supplement.
YOU CAN ALSO READ  OSTEOPOROSIS TREATMENT, OSTEOPOROSIS PREVENTION &OSTEOPOROSIS RISK FACTORS

 

"Addison's Disease Treatment"

 

Nursing Care

  • Give steroids as advised
  • Ensure Patient takes adequate milk to counteract the effect of the steroids
  • Keep patient in quiet environment with adequate ventilation.
  • Protect the patient from cold and infection
  • Keep patient away from infection disease patient
  • Reduce the number of visitors.
  • Monitor vital signs 6 hourly and be alert to elevation of temperature which maybe early symptoms of infection and dehydration
  • Observe for signs of Sodium and electrolyte imbalance, monitor fluid intake and output weigh patient regularly, Emphasize intake of prescribed diet and fluids.
  • Treat vomiting with antemetics as advised to prevent further loss of electrolyte
  • Provide enough emotional support for patient and family
  • Make patient understand the importance of adhering to both therapeutic and dietetic solution
  • Maintain full rest but alternate with some mild activities of daily living.

 

"Addison's Disease Treatment"

 

Complication

Psychotic disturbances, hyper pyrexia, hypotension, coma, death

 

Prognosis

  • Provided substitution therapy is maintained patient prognosis is excellent.
  • A patient with relatively severe Addison’s disease can enjoy a life just moderately restricted

 

"Addison's Disease Treatment"

 

Be the first to comment

Leave a Reply

Your email address will not be published.


*