Nonspecific! Early: fatigue, weight loss, vomiting, pigmentation. Pigmentation affects sun exposed areas, palmar creases, buccal mucosae, axillae, new scars. May be associated vitiligo.
Addisonian crisis: Low-grade fever, shock, ↓glucose. May be precipitated by stress (infection, surgery).
1° hypoadrenalism: glucocorticoid + mineralocorticoid deficiency.
2° hypoadrenalism: glucocorticoid deficiency only.
Pigmentation is due to increased ACTH secretion by pituitary. Precursor molecule is pro-opiomelanocortin (POMC), from which melanocyte stimulating hormone (MSHs) and MSH-like molecules are also produced in equimolar amounts.
Acute: hydrocortisone 100 mg iv qds.
1 l dextrose-saline iv in 1 h. Clinical improvement in 6 h.
Day 2: hydrocortisone 50 mg iv qds.
Day 3: hydrocortisone 40 mg po mane, 20 mg po nocte.
Day 4: hydrocortisone 20 mg po mane, 10 mg po nocte.
Chronic: hydrocortisone 20 mg mane, 10 mg nocte. (If required) fludrocortisone 100 µg od.
Issue MedicAlert bracelet & steroid card.
Surgery: 100 mg hydrocartisone po in pre-medication. Then as for acute crisis.