Addison Disease Medication

  • Author: Elizabeth A Liotta, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jun 7, 2010
 

Medication Summary

With optimum dosing (which is often a challenge), the glucocorticoids are adequately replaced with minimal adverse effects. Underdosing of glucocorticoids results in continued adrenal insufficiency. In children, nocturnal hypoglycemia can result in seizures. Overdosing of glucocorticoids results in weight gain, increased blood pressure, and osteoporosis. The effects of steroid replacement are assessed with clinical examination.

The resolution of symptoms and the correction of electrolyte abnormalities are the customary signals in determining the adequacy of replacement. In patients at risk for osteoporosis, monitor serum and urine cortisol levels; this method appears to be the best available assessment of steroid dosing.

The titration of mineralocorticoid replacement is achieved by monitoring electrolyte levels and plasma rennin concentrations and by evaluating clinical findings such as dizziness or weight gain. Weakness, decreased diastolic blood pressure, low serum sodium levels, and increased plasma rennin concentrations occur with an underdosing of fludrocortisone. Overdosing is difficult to determine. Decreased serum potassium levels may be seen. Increased levels of atrial natriuretic peptide have been proposed to be more accurate in determining an overdose.[12]

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Corticosteroids

Class Summary

These agents are used to restore corticosteroid levels. Some cases of multifocal disseminated lipoatrophy as a result of IV corticosteroid administration have been reported in these patients with adrenal insufficiency.[13]

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Cortisone (Cortone)

 

DOC for patients with adrenocortical insufficiency.

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Hydrocortisone (Hydrocortone, Cortef)

 

DOC because of mineralocorticoid activity and glucocorticoid effects. Some cases of multifocal disseminated lipoatrophy as a result of IV corticosteroid administration have been reported in these patients with adrenal insufficiency.

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Fludrocortisone (Florinef)

 

Used for partial replacement therapy in primary and secondary adrenocortical insufficiency.

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Dexamethasone (Decadron, Baldex, Dexone)

 

DOC for patients with adrenocortical insufficiency.

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Contributor Information and Disclosures
Author

Elizabeth A Liotta, MD  Assistant Professor, Department of Dermatology, Uniformed Services University of the Health Sciences

Elizabeth A Liotta, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Alexander Brough, MD  Consulting Surgeon, Department of Dermatology, Sewell's Point Clinic

Alexander Brough, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Robin Travers, MD  Assistant Professor of Medicine (Dermatology), Dartmouth University School of Medicine; Staff Dermatologist, New England Baptist Hospital; Private Practice, SkinCare Physicians

Robin Travers, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Informatics Association, Massachusetts Medical Society, Medical Dermatology Society, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD  Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Medicis Honoraria Consulting; Celgene Honoraria Consulting

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Bergthorsdottir R, Leonsson-Zachrisson M, Oden A, Johannsson G. Premature mortality in patients with Addison's disease: a population-based study. J Clin Endocrinol Metab. Dec 2006;91(12):4849-53. [Medline].

  2. Burk CJ, Ciocca G, Heath CR, Duarte A, Dohil M, Connelly EA. Addison's disease, diffuse skin, and mucosal hyperpigmenation with subtle "flu-like" symptoms--a report of two cases. Pediatr Dermatol. Mar-Apr 2008;25(2):215-8. [Medline].

  3. Lamey PJ, Carmichael F, Scully C. Oral pigmentation, Addison's disease and the results of screening for adrenocortical insufficiency. Br Dent J. Apr 20 1985;158(8):297-8. [Medline].

  4. Shah SS, Oh CH, Coffin SE, Yan AC. Addisonian pigmentation of the oral mucosa. Cutis. Aug 2005;76(2):97-9. [Medline].

  5. Prat C, Vinas M, Marcoval J, Jucgla A. Longitudinal melanonychia as the first sign of Addison's disease. J Am Acad Dermatol. Mar 2008;58(3):522-4. [Medline].

  6. Adams R, Hinkebein MK, McQuillen M, Sutherland S, El Asyouty S, Lippmann S. Prompt differentiation of Addison's disease from anorexia nervosa during weight loss and vomiting. South Med J. Feb 1998;91(2):208-11. [Medline].

  7. Albert E, Dalaker K, Jorde R, Berge LN. Addison's disease and pregnancy. Acta Obstet Gynecol Scand. 1989;68(2):185-7. [Medline].

  8. Kita M, Mandala E, Saratzis A, et al. Primary adrenal lymphoma presenting as Addison's disease. Case report and review of the literature. Exp Clin Endocrinol Diabetes. Jun 2008;116(6):363-5. [Medline].

  9. Baker DE, Glazer GM, Francis IR. Adrenal magnetic resonance imaging in Addison's disease. Urol Radiol. 1988;9(4):199-203. [Medline].

  10. Arlt W, Callies F, van Vlijmen JC, Koehler I, Reincke M, Bidlingmaier M, et al. Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Engl J Med. Sep 30 1999;341(14):1013-20. [Medline].

  11. Oelkers W. Dehydroepiandrosterone for adrenal insufficiency. N Engl J Med. Sep 30 1999;341(14):1073-4. [Medline].

  12. Cohen N, Gilbert R, Wirth A, Casley D, Jerums G. Atrial natriuretic peptide and plasma renin levels in assessment of mineralocorticoid replacement in Addison's disease. J Clin Endocrinol Metab. Apr 1996;81(4):1411-5. [Medline].

  13. Bauerschmitz J, Bork K. Multifocal disseminated lipoatrophy secondary to intravenous corticosteroid administration in a patient with adrenal insufficiency. J Am Acad Dermatol. May 2002;46(5 Suppl):S130-2. [Medline].

  14. Ai J, Leonhardt JM, Heymann WR. Autoimmune thyroid diseases: etiology, pathogenesis, and dermatologic manifestations. J Am Acad Dermatol. May 2003;48(5):641-59; quiz 660-2. [Medline].

  15. Betterle C, Volpato M. Adrenal and ovarian autoimmunity. Eur J Endocrinol. Jan 1998;138(1):16-25. [Medline].

  16. Burke MP, Opeskin K. Adrenocortical insufficiency. Am J Forensic Med Pathol. Mar 1999;20(1):60-5. [Medline].

  17. Dunlop D. Eighty-six cases of Addison's Disease. Br Med J. Oct 12 1963;5362:887-91. [Medline].

  18. Grant DB, Barnes ND, Moncrieff MW, Savage MO. Clinical presentation, growth, and pubertal development in Addison's disease. Arch Dis Child. Oct 1985;60(10):925-8. [Medline].

  19. Grinspoon SK, Biller BM. Clinical review 62: Laboratory assessment of adrenal insufficiency. J Clin Endocrinol Metab. Oct 1994;79(4):923-31. [Medline].

  20. Hahner S, Loeffler M, Bleicken B, Dreschsler C, Milovanovic D,Fassnacht M, et al. Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies. Eur J Endocrinol. Mar 2010;162:597-602.

  21. Hunt G, Todd C, Kyne S, Thody AJ. ACTH stimulates melanogenesis in cultured human melanocytes. J Endocrinol. Jan 1994;140(1):R1-3. [Medline].

  22. Jabbour SA. Cutaneous manifestations of endocrine disorders: a guide for dermatologists. Am J Clin Dermatol. 2003;4(5):315-31. [Medline].

  23. Jeffcoate W. Assessment of corticosteroid replacement therapy in adults with adrenal insufficiency. Ann Clin Biochem. Mar 1999;36 ( Pt 2):151-7. [Medline].

  24. Kong MF, Jeffcoate W. Eighty-six cases of Addison's disease. Clin Endocrinol (Oxf). Dec 1994;41(6):757-61. [Medline].

  25. Laureti S, Vecchi L, Santeusanio F, Falorni A. Is the prevalence of Addison's disease underestimated?. J Clin Endocrinol Metab. May 1999;84(5):1762. [Medline].

  26. Luken KK. Clinical manifestations and management of Addison's disease. J Am Acad Nurse Pract. Apr 1999;11(4):151-4. [Medline].

  27. Mason AS, Meade TW, Lee JA, Morris JN. Epidemiological and clinical picture of Addison's disease. Lancet. Oct 5 1968;2(7571):744-7. [Medline].

  28. Michels AW, Eisnbarth GS. Immunologic endocrine disorders. J Allergy Clin Immunol. Feb 2010;125:S226-37.

  29. Nerup J. Addison's disease--clinical studies. A report fo 108 cases. Acta Endocrinol (Copenh). May 1974;76(1):127-41. [Medline].

  30. Nieman LK, Chanco Turner ML. Addison's disease. Clin Dermatol. Jul-Aug 2006;24(4):276-80. [Medline].

  31. Orth DN, Kovacs WJ. The adrenal cortex. In: DeGroot LJ, Jameson JL, eds. William's Textbook of Endocrinology. 9th ed. Philadelphia, Pa: WB Saunders; 1998.

  32. Tobin MV, Aldridge SA, Morris AI, Belchetz PE, Gilmore IT. Gastrointestinal manifestations of Addison's disease. Am J Gastroenterol. Oct 1989;84(10):1302-5. [Medline].

  33. Van den Driessche A, Eenkhoom V, Van Gaal L, De Block C. Type 1 diabetes and autoimmune polyglandular syndrome: a clinical review. Neth J Med. Dec 2009;67:376-87.

  34. Villabona CM, Sahun M, Ricart W, Serres X, Maroto A, Fernandez-Real JM, et al. Tuberculous Addison's disease. Utility of CT in diagnosis and follow-up. Eur J Radiol. Nov 1993;17(3):210-3. [Medline].

  35. White K, Arlt W. Andrenal crisis in treated Addision's disease: a predictable but under-managed event. Eur J Endocrinol. Jan/2010;162:115-120.

  36. Wilson R, Lee A, Jorizzo J,. Subacute Addison disease mimicking Laugier-Hunziker syndrome. JAAD. Mar/2010;62:AB121.

 
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Hyperpigmented scar on diffusely hyperpigmented (tanned) skin. Courtesy of Dirk M. Elston, MD.
Hyperpigmented scars from ear piercing. Courtesy of Dirk M. Elston, MD.
Pigmented patches of mucous membrane and pigmented longitudinal nail bands. Courtesy of Dirk M. Elston, MD.
Hyperpigmented gingival patches. Courtesy of Dirk M. Elston, MD.
 
 
 
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