Presentation
This enhanced eBook experience allows you to search all of the text, figures, and references on a variety of devices, as well as access interactive online case presentations for effective exam review. [books.google.com]
The most common symptoms are non-specific and diagnosis is therefore often delayed and patients may first present with a life-threatening crisis. [jpccr.eu]
‘There is no disease’, wrote Sir Zachary, ‘other than Addison’s disease that could present a face that was “black and white” and at the same time give rise to the other symptoms described in her letters.’ [healthdoctrine.com]
We present a case report of a middleaged male with histopathologically proven tuberculosis with Addison's disease. [uthsc.pure.elsevier.com]
We also present the follow up of our patient after three years. [panafrican-med-journal.com]
Workup
Workup for active tuberculosis, such as sputum for acid fast bacilli (AFB), Mantoux test, fiberoptic bronchoscopy and bronchoalveolar lavage for AFB, and urine for AFB, revealed no evidence of activity. [esim.eg.net]
Addison Disease workup at eMedicine Further reading [ edit ] Bornstein, SR; Allolio, B; Arlt, W; Barthel, A; Don-Wauchope, A; Hammer, GD; Husebye, ES; Merke, DP; Murad, MH; Stratakis, CA; Torpy, DJ (February 2016). [en.wikipedia.org]
Further workup of anemia revealed hypochromic cells with anysocytosis on peripheral blood smear, serum iron 20 µg/dL, total iron binding capacity 108 µg/dL and iron saturation 22%. [asean-endocrinejournal.org]
Thomas Addison first described the clinical presentation of primary adrenocortical insufficiency in 1855 in his classic paper, On the Constitutional and Local Effects of Disease of the Supra-Renal Capsules. [1] Workup The diagnosis of adrenocortical insufficiency [emedicine.medscape.com]
Treatment
The proportion of nonresponders decreased from 50% before treatment to 30% after treatment; androgen function did not improve in any of the cases. [esim.eg.net]
Treatment may also include taking a medication that helps restore the body's level of sodium and potassium. [stanfordchildrens.org]
[…] in first-line treatment: Rifampin, Isoniazid, Pyrazinamide, and Ethambutol. [amboss.com]
[…] it can be punctate, localized, or diffuse gland density: central low density can be seen in early disease due to caseous necrosis with anti-TB treatment the adrenals show homogenous density enhancement: can see areas of relative central hypoenhancement [radiopaedia.org]
Addison’s Disease Treatment Oral Hydrocortisone 3 x day (15mg-30mg in total – less at night due to insomnia risk). Oral Fludrocortisone once/day to replace Aldosterone. Treatment delay may be fatal in hypoglycaemic patients! [positivehealth.com]
Prognosis
The prognosis for any patient with adrenal insufficiency will depend on the underlying cause. In those patients in whom the prognosis is not affected by the underlying pathology, replacement therapy should result in a return to health. [patient.info]
Prognosis & Response totherapyLife expectancy is usually normal with good compliance.It is important to make sure that pt is taking medications regularly and knowledgeable about his condition.BP without orthostatic hypotension, normal lytes, PRA 28. [slideshare.net]
In spite of treatment with sulphonamides, antibiotics, and steroids, the prognosis is still extremely poor. [intechopen.com]
[…] normally presents concurrently with pulmonary TB Clinical features Diagnosis Sepsis tuberculous accutissima (Landouzy septicemia, typhobacillosis of Landouzy) Description: septic progression of primary TB in an immunocompromised patient with a very poor prognosis [amboss.com]
Clinical profile and prognosis of Addison′s disease in India. Natl Med J India 2001; 14:23-25. 2. Kelestimur F, Unlui Y, Ozesmi M, Tolu 1. [esim.eg.net]
Etiology
Abstract Since Addison's classic and comprehensive description of the disease bearing his name, 1, 2 accepted etiologic factors have included tuberculosis and cytotoxic contracted adrenals (atrophy) almost exclusively. [annals.org]
Nerup [10] reported that the majority (66%) had idiopathic type of AD, whereas only 7% had tuberculosis etiology. In developing countries, around 50% of the patients with AD have a tubercular etiology [1]. [esim.eg.net]
At 1855, when Addison described it tuberculosis (TB) was the main etiology. May be we are coming to that time. TB is an infectious disease caused by Mycobacterium tuberculosis. [endocrine-abstracts.org]
Pathogen host: predominantly humans Mycobacterium bovis : Common pathogen causing gastrointestinal tuberculosis Mechanism of infection: predominantly via ingestion of contaminated cow's milk Pathogen reservoir: predominantly cattle References: [4] [5] Etiology [amboss.com]
Lee Learning points for clinicians Chest wall tuberculosis may resemble a pyogenic abscess or tumor and entertaining the possibility of tubercular etiology remains a clinical challenge. [academic.oup.com]
Epidemiology
Epidemiology Sex : (2:1) United States Globally The incidence of multidrug-resistant tuberculosis is steadily rising. References: [1] [2] [3] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
EPIDEMIOLOGY Prevalence: 12 per 100,000 persons Incidence: 0.5 per 100,000 persons Age: may occur at any age, with peak incidence in the fourth decade Sex: Autoimmune causes: female predominance Non-autoimmune causes: equal sex distribution 10. [slideshare.net]
Epidemiology Frequency United States The prevalence of Addison disease is 40-60 cases per 1 million population. International The occurrence of Addison disease is rare. [emedicine.medscape.com]
[…] process, and/or acute withdrawal of long-term corticosteroid therapy (defined as 3 months use of steroid) System(s) affected: endocrine/metabolic Synonym(s): adrenocortical insufficiency; corticoadrenal insufficiency; primary adrenocortical insufficiency Epidemiology [unboundmedicine.com]
Epidemiology [ 1, 2 ] Primary insufficiency - this is a relatively rare condition. The annual incidence is about 1 in 10,000 people, with a prevalence in the UK of about 8,400. Across Europe, prevalence is estimated as 93-144 per million. [patient.info]
Pathophysiology
References: [7] [8] [9] Pathophysiology Clinical features Latent infection Asymptomatic The patient is not contagious. [amboss.com]
Predominant sex: females and children males (slight) No racial predilection Incidence 0.6/100,000 Prevalence 40 to 60 cases in 1 million population Etiology and Pathophysiology Autoimmune adrenal insufficiency ( 80% in United States) Infectious causes [unboundmedicine.com]
The pathophysiology of this is not yet clear. It involves reduction in the production of glucocorticoids as well as reduced effect. [patient.info]
[…] the body, especially lung ), hemorrhage (e.g. in Waterhouse–Friderichsen syndrome or antiphospholipid syndrome ), particular infections ( tuberculosis, histoplasmosis, coccidioidomycosis ), or the deposition of abnormal protein in amyloidosis. [22] Pathophysiology [en.wikipedia.org]
The main causes of sudden death due to adrenal gland pathology will be examined, paying particular attention to the pathophysiology of sudden death, macroscopic and microscopic characteristics and their correlation with clinical features. [intechopen.com]
Prevention
Adrenal metastases were thus excluded and probably Addison's disease, considered to be a potential complication of adrenal tuberculosis, could be prevented. [ncbi.nlm.nih.gov]
Preventing Addisonian Crisis Currently, there are no known methods to prevent Addison’s disease. However, steps can be taken to prevent Addisonian crisis in people already diagnosed with the disease. [innerbody.com]
Chronic steroid use, then experiencing severe infection, trauma, or surgical procedures General Prevention Focus on prevention of complications. Anticipate adrenal crisis and treat before symptoms begin. [unboundmedicine.com]
There is no evidence that treatment can prevent this autoimmune attack, which may also affect other organs in the same person. [netdoctor.co.uk]