BRIEF DESCRIPTION ABOUT ADDISONS DISEASE FOR DENTAL AND MEDICAL STUDENTS AND FOR GRADUATES AND FOR UNDERGRADUATES WHO FIND IT DIFFICULT TO UNDERSTAND FROM THE MEDICAL PUBLICATONS ABOUT THIS DISEASE AND ITS DIAGNOSIS AND ALSO DIFFERENTIAL DIAGNOSIS.

1. ADDISON’S DISEASE
PREPARED BY
AIJIN.A.MOHAN

2. ADDISON’S DISEASE
Addison’s disease is also called adrenal insufficiency
Addison’s disease is a hormonal disorder resulting from
a severe or total deficiency of the hormones made in the
adrenal cortex.
Clinically the disease is characterized by bronzing of the skin
and a pigmentation of the mucous membrane.
Both oral and skin pigmentation are thought to be result from
melanocytes stimulating hormonal activity.

3. Addison’s disease is an un common condition
estimated to occur in 1 in 100000 of the population.
PREPARED BY
AIJIN.A.MOHAN

4. ETIOLOGY
TUBERCULOSIS-It was a leading cause of addison’s
disease until the antibiotics were introduced that
successfully treated T.B.
Autoimmune disorders-Here the body’s immune
system makes antibiotics which cells of the adrenal
cortex and slowly destroys them.
Adrenocortical destruction-Bilateral adrenocortical
destruction after T.B or fungal infection and an
idiopathic atrophy are the most frequent causes .
PREPARED BY
AIJIN.A.MOHAN

5. Others- Occasionally , bilateral tumor metastasis
leukemic infiltration and amyloidosis of the
adrenal cortex have been found to be responsible
,other less common causes include cancer ,
chronic infection , Cytomegalovirus , surgical
removal of adrenal glands.
Whatever may be the cause the loss of adrenal
cortex results in deficiency in both glucocoticoids
and mineralocorticoids
PREPARED BY
AIJIN.A.MOHAN

6. PATHOGENESIS
ACTH and MSH are similar in structure and ACTH is
believed to have some degree of melanocyte stimulating
activity.
Normally pituitary gland produces ACTH which causes
adrenal cortex to produce glucocorticoids which inturn
secreted into the circulation .When glucocorticoids reach
a certain concentration in the blood they cause the
anterior pituitary to cease the production of the ACTH . In
Addison’s disease however the defective cortex is unable
to produce much glucocorticoid , so this feedback
mechanism is not activated and the pituitary continues to
produce ACTH .As a result increased production of
melanin changes the colour of skin in a smoky tan or
chestnut brown..

7. 1- ADRENAL GLANDS

8. Clinical features
Signs and symptoms - Fatigue , weakness , weight
loss , abdominal pain , vomiting and mood
disturbances (maniac,deppressive) . These
symptoms worsen overtime due to the slowly
progressive loss of cortisol and aldosterone
production.
Skin signs :
HYPER PIGMENTATION- It is most evident in areas
exposed to light, but also affects the body folds, the
sites of pressure and friction and in the areas of palm
and soles.
It is also prominent on the gums , buccal mucosa
,nipple , armpits , genitals

9. Women may have loss of androgen stimulated hair
such as pubic and under arm hair.
PIGMENTATION : Pigmentation usually appears
early and is one of the most prominent signs of the
disease.
The more usual being deep tanning of the skin and
mucous membrane with heavier deposits of melanin
over pressure points such as cheek . The increased
melanocytic activity is expressed by the development
of distinct brownish macule on the oral mucosa and
the skin.
COLOUR OF PIGMENTATION : Bluish black to pale
brown or deep chocolate spreading over buccal
mucosa from the angle of mouth or developing on the
gingiva tongue and lips.

11. HYPERPIGMENTATION
PREPARED BY
AIJIN.A.MOHAN

12. PIGMENTATION OF BUCCAL MUCOSA

13. HYPERPIGMENTATION OF THE LIPS
PREPARED BY
AIJIN.A.MOHAN

14. DIAGNOSIS`
Test’s measuring cortisol and aldosterone blood
and urine levels must be performed to make a
definite diagnosis.
The diagnosis of addison’s disease is
based on the clinical sign as well as on
characteristic changes in the blood
sodium and chloride levels.
PREPARED BY
AIJIN.A.MOHAN

15. DIFFERENTIAL DIAGNOSIS
Hyper pituitarism- It can be distinguished by the
use of urine test levels of 17-ketosteroid in the urine
are decreased in the former but elevated in the latter
condition . A history of silver ingestion identifies
argyra.
Peutz-jeghers syndrome , Albrights syndrome
and Recklinhausens disease- The macular type of
discolouration that occasionally develop in place of
more generalized tanning might be mistaken for
peutz jegher’s syndrome , albrights syndrome or von
recklinghausens disease. PREPARED BY
AIJIN.A.MOHAN

16. PEUTZ JEGHERS SYNDROME
PREPARED BY
AIJIN.A.MOHAN

17. VON RECKLINGHAUSENS DISEASE
PREPARED BY
AIJIN.A.MOHAN

18. ALBRIGHTS SYNDROME
PREPARED BY
AIJIN.A.MOHAN

19. MANAGEMENT
It is done by adequate corticosteroid
maintenance therapy provided by an
average daily dose of 25-40 mg
cortisone.
PREPARED BY
AIJIN.A.MOHAN

20. THANK YOU
PREPARED BY
AIJIN.A.MOHAN