ADDISON’S DISEASE (Supra-renal insufficiency)

ADDISONS


Ques. 1 What is Addison’s Disease?
Ans. This is a condition characterized by asthenia, hypotension, wasting, pigmentation of skin and mucous membrane, and deranged mineral and carbohydrate metabolism due to hypo-function of the Adrenal Cortex, as a result of bilateral destruction. 

Ques. 2 What are the causes symptoms, signs and clinical features of Addison’s disease?
Ans. Causes :
a) Syphilis, hypopituitarism, leukaemia etc.
b) Malignancy.
c) Infiltrative disease, e,g. Hodgkin’s disease, Amyloidosis.
d) Prolonged cortico steroid therapy.
e) Congenital adrenal hyperplasia.
f) Idiopathic adrenal atrophy.
g) Tuberculosis.

Clinical Features : Onsent-gradual, Age between 30 to 50 years.
Symptoms –
I. Poor concentration.
II. Hypotension.
III. Nausea, vomiting, diarrhoea, anorexia etc.
IV. Craving for salt. Weight loss (cachexia).
V. Dizziness and syncopal attacks.
VI. Restlessness.
VII. Insomnia.
VIII. Depression and apathy.
IX. Amenorrhoea (in females).
X. Weakness and fatigability.
XI. Pigmentation – both skin and mucous membrance due to excessive liberation of melanotic stimulating hormone. Back of neck, dorsum of hand & forearm, wrist line. Axilla, bony prominences etc. In mucous membrane-brownish patch, in soft palate, inside cheek, side of the tongue, gums and inner surface of lips.
Signs :
a) Effortful speech.
b) Hypotension and low body temperature.
c) Small heart with feeble action.
d) Diffuse abdominal tenderness.
e) In crisis alarming prostration, dehydration, nausea and vomiting.
f) Absent axillary or pubic hair, especially in women.
g) Loss of weight (eachexia).
h) Abnormal pigmentation.
Investigations :
I. Serum Sodium-low.
II. Serum chlorides-low.
III. Serum potassium-raised.
IV. Gastric analysis-low gastric acidity.
V. Water loading tests-impaired excretion of water.
VI. Glucose tolerance test-low flat curve.
VII. Urinary 17 ketosteroids-low.
VIII. Eosinophil count-high.
Complications :
a) Tuberculous lesion in other places.
b) Secondary infection, e.g. pneumonia etc.
c) Hypo or hyperthyroidism or glycosuria.
Differential Diagnosis :
I. The distinction between adrenal insufficiency due to Addision’s disease and secondary to pituitary failure is that pigmentation does not occur in latter.
II. Addision’s disease is distinguished from cancer of pylorus, showing sallowness of the skin by its distinctive symptoms of low blood pressure.

Ques. 3 What is the treatment of Addison’s disease?
a) Treatment of underlying cause.
b) For crises-Rest in bed, kept warm and given 1000 to 1500 ml. of 0.9% sodium chloride and 5 to 10% dextrose solution I.V.
c) Homoeopathic remedies.
d) In mild cases addition of extra salt in the diet.
e) In moderate and severe cases-replacement therapy is required.

Ques. 4 Which medicines are good for Addison’s disease?
Ans. 1) NATRUM MUR – Great weakness and weariness, great debility, craving for salt. Greasy and oily skin and sometimes discolouration. Unquenchable thirst, amenorrhoea.
2) PHOSPHORUS – Weakness and fatigability, pigmentation of skin, fearfulness hoarseness, vomiting with loss of appetite. Thirst for very cold water sleeplessness.
3) ARGENTUM NIT – Loss of appetite, chronic wasting and diarrhoea, skin brown, tense and hard, great desire for sweets. loss of control and want of balance every where, mentally and physically.
4) ARSENICUM – Burning and discolouration of skin & mucous membrane. Nervous depression, general debility ; feeble heart action & tendency to vomit, anxious and restlessness and nightly aggravation.

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