Sunday, September 27, 2009

Addison Disease in MRCP (2)

Addison Disease in MRCP (2)

I strong believe that Addison Disease is a difficult diagnosis to make in clinical medicine. Anyway, there are a few points to remember if you are sitting for your MRCP,

1) The commonest cause of Addison disease is autoimmune in origin ( about 70%). Antibodies to 21-hydroxylase are commonly found.

2) There is long list of other causes, however, always remeber that it may be associated with infection ( especially tuberculosis) and autoimune polyglandular deficiency, therefore always look for other endocrine deficiency if you pick up Addison disease in a patient.

3) I think the common scenario they give you in your MRCP is a patient with chronic fatigue ( sometimes chronic diarrhoe) with the following abnormalities,

a) hyponatremia and hyperkalemia ( I hope you know the reason behind this!)
b) hypoglycemia
c) hypotension
d) pigmentation ( remember your ACTH??)- look at mucosal and palmar creases. A popular MRCP PACES short case!!

( Picture source:pathmicro.med.sc.edu)


It is easy to make a diagnosis, your adrenal should secrets cortisol if stimulated by ACTH, therefore, if your body fails to secrets cortisol to a certain level after ACTH ( synacthen test), that it means you have adrenal insufficiency ( Addison disease)


About the treatment, of course if patient comes in with crisis, treat accordingly and later put patient glucocorticoid therapy and if possible find out the underlying cause!

Thursday, September 24, 2009

Other than Medicine

Other than Medicine

I am very......very sorry being quiet for months!! As I progress to another stage of my life, I suddenly realize that there are other important matters other than medicine.

I hope you bear with me because this post has nothing to do with MRCP and medicine.

Yes, I am so happy that I have my second baby, some of you might know that besides medicine, I enjoy a lot of hobbies, I like programming, investing, travelling and of course sleeping.

One afterenoon in my new hospital, I sat down in one of the corner near my hospital and spent 5 min with myself and started to think what I want to do with my life.

For the last 8 years, I spent most of my time in hospital and I worked very hard , after seeing lives and deaths everyday, I actually do not know my destiny. A few years back, there was only one aim in my life- passing my MRCP, but now, what's next??

I feel a lot of us just work everyday and give the patients most of our times, I remember clearly my last holiday with my wife was actually 4 years ago!! Both of us just work and work again because we are so worried that we might not have enough money to raise our kids and for our retirement!


Just want to share with all of you, look beyond, MRCP is just a stop in your life, you have more things to do after your MRCP. Even though you do not pass your MRCP, don't be upset, you might have other better things to do in life than medicine!