<prompt> Addison disease is commonly associated with:Autoimmune adrenalitisAdrenocortical carcinomaHypernephromaMedullary carcinoma of thyroid  <response>: Ans. A Autoimmune adrenalitisRef: Harrisons Principle of Internal Medicine 20th Ed; Page No-2733Autoimmune adrenalitis is the most common etiology of primary adrenal insufficiency.Patients with Adrenocortical carcinoma presents with features of adrenocortical hormones excess Cushings syndrome.Hypernephroma and medullary carcinoma of thyroid are not associated with Addisons disease.Addisons DiseaseAutoimmune Most common in world wide.TB: Most common in India.It occurs due to sudden stoppage of steroids. Addisonian Crisis.Clinical Sign:AnorexiaPolyuria: 3L24 hrsWeight loss, FatigueWeakness with hypotensionLoss of pubicaxillary hair.Thin patient with hyperpigmented skinLaboratory abnormalities:Hyponatremia Normal Value: 135-145 mEq.Hyperkalemia Normal Valve: 3.5-5.5 mEq with a mild metabolic acidosis from the inability to excrete either H or K because of the loss of aldosterone.Hypoglycemia and neutropenia: Glucocorticoids increase glucose and white cell levels.Diagnostic TestingCosyntropin synthetic ACTH stimulation test: It measures the level of cortisol before and after the administration of cosyntropin.CT scan of the adrenal gland: Evidence of damage gland.Gene XPERT for MTB.TreatmentSteroid replacement is DOC in adrenal insufficiency acute and chronic and congenital adrenal hyperplasia. Hydrocortisone is the steroid of choice in Addisons disease.The doses of steroids:Children: 10 mgm2day in three dived dosesAdults: 15-30 mgm2day in three dived dosesDrug of Choice for Addisonian crisis: IV hydrocortisone Fluid resuscitationPrednisone: For stable patients non-hypotensive.Fludrocortisone: It promotes salt and water retention. It is used for patients with adrenal insufficiencies who are still hypotensive after initial replacement with prednisone.Dexamethasone: Cortisol like activity; but reduces hypoglycemic symptoms. 