Intended for healthcare professionals

Education And Debate

Lesson of the Week: Addison's disease

BMJ 1996; 312 doi: (Published 27 April 1996) Cite this as: BMJ 1996;312:1085
  1. C M Brosnan,
  2. N F C Gowing
  1. St Helier Hospital, Carshalton, Surrey SM5 1AA CM Brosnan, registrar in anaesthetics.
  2. Royal Marsden Hospital, London SW3 6JJ NFC Gowing, emeritus professor of pathology.
  1. Correspondence to: Dr Brosnan.
  • Accepted 18 December 1995

Primary adrenocortical insufficiency (Addison's disease) is a rare disorder in which there is destruction of the adrenal cortex, thus reducing the production of glucocorticoid, mineralocorticoid, and sex steroids.1 2 Most cases are now due to autoimmune disease3 and occur more often in patients with an HLA-DR3 and HLA-B8 tissue type. The disease may be associated with other immune disorders, including thyroid disease, diabetes mellitus, pernicious anaemia, hypoparathyroidism, and ovarian failure. We report two fatal cases of autoimmune Addison's disease that were diagnosed only at necropsy.

Case reports CASE 1

A 26 year old man was admitted to hospital with a history of two to three days of nausea and vomiting and increasingly frequent watery stools. He had also complained of a sore throat for two to three days, for which his family doctor had prescribed pivampicillin. He had not travelled overseas nor had he eaten any food outside his own home. He worked as a security officer near the Thames but never swam there. He had no previous history of weight loss, abdominal pain, or cardiovascular symptoms nor any important past medical history.

Initial examination showed him to be dehydrated with a temperature of 37.5°C, a pulse rate of 120 beats a minute, and blood pressure of 85/60 mm Hg (with no postural drop). No hyperpigmentation of skin creases or mucous membranes was noted. His tonsillar bed was inflamed. Examination of his abdomen was unremarkable. Haematological investigations gave normal results, in particular sodium 135 mmol/l (normal range 135-150 mmol/l), potassium 5.9 mmol/l (normal range 3.5-5.3 mmol/l), creatinine 233 µmol/l, urea 15.4 mmol/l, and glucose 3.9 mmol/l (normal range 3.0-8.0 mmol/l).

His electrocardiogram showed a sinus tachycardia with a normal axis, voltage, and T waves. A chest x ray picture revealed a normal heart with normal lung fields. Urine analysis and microscopy were …

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