Symptoms

1. Fatigue and muscle weakness

1.1. Worsens while standing

2. Darkened skin colour (hyperpigmentation)

2.1. Tanned skin in places not exposed to sun

2.2. Old scars darken

2.3. Darkening common in creases of hands

3. Fever, headache

4. Nausea, vomiting, diarrhea, weight loss

5. Craving salty foods

6. Inability to smell or decreased ability to smell (anosmia)

7. Stunted Sexual Growth, Delayed Puberty

7.1. Male

7.1.1. Micropenis

7.2. Female

7.2.1. delayed secondary sexual characteristics (breasts)

8. Optical problems (ex. colour blindness, optic atrophy)

9. Chest pains

10. Suspected of: Addison's Disease

10.1. Hormone involved: ACTH (Adrenocorticotropic hormone)

10.1.1. Secreted by anterior pituitary gland

10.1.1.1. Secreted in response to CRH (Corticotropin releasing hormone)

10.1.2. Stimulates release of hormones related to stress responses

10.1.3. Targets adrenal gland

10.1.3.1. Binds to signal receptor on target cell, invoking a chemical response

10.1.4. Uses endocrine signaling

10.1.5. Composed of amino acids

10.2. Tests & Diagnosis

10.2.1. ACTH stimulation test (Short ACTH test)

10.2.1.1. Blood cortisol and urine cortisol levels are measured

10.2.1.1.1. Synthetic injection of ACTH is given

10.2.1.2. Determines if there is adrenal insufficiency

10.2.2. CRH Stimulation test (Long test)

10.2.2.1. Blood cortisol measured

10.2.2.1.1. Synthetic CRH injected intravenously

10.2.2.2. Determines cause of adrenal insufficiency

10.3. Treatment

10.3.1. Substitution of missing hormones

10.3.1.1. Cortisol replaced orally with hydrocortisone tablets

10.3.1.2. Aldosterone replaced with oral doses of a mineralocorticoid called fludrocortisone acetate

10.3.1.2.1. Advise to increase salt intake

10.4. Causes

10.4.1. Failure to produce adequate levels of cortisol

10.4.1.1. Disorder of adrenal glands (Primary adrenal insufficiency)

10.4.1.1.1. Gradual destruction of adrenal glands, caused by the body's own immune system

10.4.1.1.2. 70% occur because of autoimmune disorders, where the immune system attacks the body's own tissues or organs

10.4.1.1.3. Adrenal insufficiency occurs when 90% of the adrenal cortex has been destroyed

10.4.1.2. Inadequate secretion of ACTH by the pituitary gland (Secondary adrenal insufficiency)

10.4.1.2.1. More common than primary adrenal insufficiency

10.4.1.2.2. Without ACTH, cortisol production drops but not aldosterone

10.5. Addisonian Crisis

10.5.1. Severe case of Addison's, result of undiagnosed Addison's disease or intercurrent problem in someone who has Addison's

10.5.2. Severe symptoms

10.5.2.1. Sudden pain in legs and back

10.5.2.2. Severe vomiting and diarrhea resulting in dehydration

10.5.2.3. Severe lethargy

10.5.2.4. Confusion, slurred speech

10.5.2.5. Hypoglycemia

10.5.2.6. Convulsions

10.5.3. Treat with intravenous injections of hydrocortisone, saline and dextrose (sugar), treatment is immediate

10.5.3.1. When severity has decreased, treat with oral medication

11. Suspected of: Kallmann Syndrome

11.1. Hormone involved: LH (Lutenizing hormone)

11.1.1. Secreted by anterior pituitary gland

11.1.1.1. Release from pituitary gland controlled by GnRH (Gonadotropin releasing hormone)

11.1.1.1.1. New node

11.1.2. Targets gonads (testes, ovaries)

11.1.2.1. In females, acts on ovarian follicle, inducing ovulation and maintaining corpus luteum

11.1.2.2. In males, acts on Leydig cells of testes to produce testosterone

11.1.3. Glycoprotein

11.2. Tests & Diagnosis

11.2.1. Smell test to assess degree of anosmia

11.2.1.1. Absent or exceptionally weak sense of smell is an indicator of KS

11.2.2. Gene and heriditary tests

11.2.2.1. Family history is examined. KS is often inherited genetically

11.2.3. Blood tests

11.2.3.1. Tests for LH, FSH

11.3. Treatment

11.3.1. Hormone therapy (restore missing hormones)

11.3.1.1. In males, hCG or testosterone are adminstered

11.3.1.2. In females, progestins and estrogen are administered

11.4. Causes

11.4.1. KS is mainly genetically linked

11.4.1.1. Malfunction of genes KAL1, KAL2, KAL3