NRSG 663 Addison Disease (AD): Case Study 5

Addison Disease (AD): Case Study 51 (pp. 244­248) The case study for Addison Disease (AD) is a 48 year old, female, white woman. She presents to the primary care provider, with fatigue, low energy, and an unusual tan. Q1: What is the major significance of this patient’s family history? The patient has two sisters with Hashimoto thyroiditis and one sister with Graves disease, which are both autoimmune conditions of the thyroid and closely related to AD. The mother has rheumatoid arthritis and the father died from cardiac arrest at age 65. The brother has no medical history. With multiple autoimmune disorders within the family there appears to a familial link to these conditions. Polyglandular autoimmune disease (PGAD) type II has some degree of genetic susceptibility and usually presents in adulthood with AD and without hypoparathyroidism. It is commonly associated with Hashimoto thyroiditis (one cause of hypothyroid disease), Graves disease (one cause of hyperthyroidism), vitiligo, type 1 diabetes mellitus, alopecia, or celiac sprue (Bruyere, 2010, p. 51­5). Q2: Why is the patient taking cyanocobalamin? The patient has been diagnosed with pernicious anemia, which is an autoimmune disease of the stomach that causes gastritis, subnormal vitamin B12 absorption, and vitamin B12 deficiency (Bruyere, 2010, p. 51­4). Cyanocobalamin is a medication for vitamin B12 replacement. Replacing B12 is necessary to maintain red blood cell production. Q3: Why is oral cyanocobalamin not an option for her condition?