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Addison's disease

      Abstract

      Addison's disease, or primary adrenal insufficiency, results in glucocorticoid and mineralocorticoid deficiency. Orthostatic hypotension, fever, and hypoglycemia characterize acute adrenal crisis, whereas chronic primary adrenal insufficiency presents with a more insidious history of malaise, anorexia, diarrhea, weight loss, joint, and back pain.
      The cutaneous manifestations include darkening of the skin especially in sun-exposed areas and hyperpigmentation of the palmar creases, frictional surfaces, vermilion border, recent scars, genital skin, and oral mucosa.
      Measurement of basal plasma cortisol is an insensitive screening test. Synthetic adrenocorticotropin 1-24 at a dose of 250 μg works well as a dynamic test. Elevated plasma levels of adrenocorticotropin and renin confirm the diagnosis.
      Treatment involves replacement of the deficient hormones.
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      References

        • Addison T.
        On the constitutional and local effects of diseases of the supra-renal capsules.
        Warren and Son, London1855
        • Tsatmali M.
        • Ancans J.
        • Yukitake J.
        • Thody A.J.
        Skin POMC peptides: their actions at the human MC-1 receptor and roles in the tanning response.
        Pigment Cell Res. 2000; 13: 125-129
        • Dunlop D.
        Eighty-six cases of Addison's disease.
        BMJ. 1963; 5362: 887-891
        • Nieman L.K.
        Dynamic evaluation of adrenal hypofunction.
        J Endocrinol Invest. 2003; 26: 74-82
        • Simpson S.L.
        Addison's disease.
        BMJ. 1950; 4689: 1164-1166
        • Sanford J.P.
        • Favour C.B.
        The interrelationships between Addison's disease and active tuberculosis: a review of 125 cases of Addison's disease.
        Ann Intern Med. 1956; 45: 56-72
        • Piedrola G.
        • Casado J.L.
        • Lopez E.
        • et al.
        Clinical features of adrenal insufficiency in patients with acquired immunodeficiency syndrome.
        Clin Endocrinol (Oxf). 1996; 45: 97-101
        • Ihde J.K.
        • Turnbull A.D.
        • Bajourunas D.R.
        Adrenal insufficiency in the cancer patient: implications for the surgeon.
        Br J Surg. 1990; 77: 1335-1337
        • Rao R.H.
        • Vagnucci A.H.
        • Amico J.A.
        Bilateral massive adrenal hemorrhage: early recognition and treatment.
        Ann Intern Med. 1989; 110: 227-235
        • Kong M.F.
        • Jeffcoate W.
        Eighty-six cases of Addison's disease.
        Clin Endocrinol (Oxf). 1994; 41: 757-761
        • Ahonen P.
        • Myllarnieini S.
        • Sipila I.
        • Perheentupu J.
        Clinical variation of autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) in a series of 68 patients.
        N Engl J Med. 1990; 322: 1829-1836
        • Betterle C.
        • Volpato M.
        • Greggio A.N.
        • Presotto F.
        Type 2 polyglandular autoimmune disease (Schmidt's syndrome).
        J Pediatr Endocrinol Metab. 1996; 9: 113-123
        • Rizzo W.B.
        X-linked adrenoleukodystrophy: a cause of primary adrenal insufficiency in males.
        Endocrinologist. 1992; 2: 177-183
        • Bergner G.E.
        • Eisenstein A.B.
        Addison's disease in the negro.
        J Clin Endocrinol Metab. 1951; 11: 322-329
        • Bor S.
        • Feiwel M.
        • Chanarin I.
        Vitiligo and its aetiological relationship to organ-specific autoimmune disease.
        Br J Dermatol. 1969; 81: 83-88
        • Grinspoon S.K.
        • Biller B.M.
        Clinical review 62: laboratory assessment of adrenal insufficiency.
        J Clin Endocrinol Metab. 1994; 79: 923-931
        • Laureti S.
        • Aubourg P.
        • Calcinaro F.
        • et al.
        Etiological diagnosis of primary adrenal insufficiency using an original flowchart of immune and biochemical markers.
        J Clin Endocrinol Metab. 1998; 83: 3163-3168
        • Moser A.B.
        • Kreiter N.
        • Bezman L.
        • et al.
        Plasma very long chain fatty acids in 3000 peroxisome disease patients and 29,000 controls.
        Ann Neurol. 1999; 45: 100-110
        • Arlt W.
        • Callies F.
        • van Vlijmen J.C.
        • et al.
        Dehydroepiandrosterone replacement in women with adrenal insufficiency.
        N Engl J Med. 1999; 341: 1013-1020
        • Libe R.
        • Barbetta L.
        • Dall'Asta C.
        • et al.
        Effects of dehydroepiandrosterone (DHEA) supplementation on hormonal, metabolic and behavioral status in patients with hypoadrenalism.
        J Endocrinol Invest. 2004; 27: 736-741
        • Coursin D.B.
        • Wood K.E.
        Corticosteroid supplementation for adrenal insufficiency.
        JAMA. 2002; 287: 236-240
        • Oelkers W.
        • L'age M.
        Control of mineralocorticoid substitution in Addison's disease by plasma renin measurement.
        Klin Wochenschr. 1976; 54: 607-612