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.0.0 RSP Endocrine > [11] Adrenal Insufficiency > Flashcards

[11] Adrenal Insufficiency Flashcards

1
Q

What is Addison’s disease also known as?

A

Primary adrenal insufficiency

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2
Q

What is Addison’s disease?

A

A rare but fatal disease whereby there is destruction of the adrenal cortex, which leads to glucocorticoid (cortisol) and mineralocorticoid (aldosterone) deficiency

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3
Q

What may the signs and symptoms of Addison’s disease be misdiagnosed as?

A

Viral infection or anorexia nervosa

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4
Q

How can Addison’s disease be differentiated from viral infection or anorexia nervosa?

A

In these conditions, potassium is decreased, but in Addison’s it is increased

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5
Q

What are the causes of Addison’s disease?

A
  • Autoimmunity
  • TB
  • Adrenal mets
  • Lymphoma
  • Opportunistic infection in HIV
  • Adrenal haemorrhage
  • Congential
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6
Q

What % of cases of Addison’s disease in the UK are caused by autoimmunity?

A

80%

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7
Q

Give 3 cancers that may metastase to the adrenals

A
  • Lung
  • Breast
  • Renal
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8
Q

Give two conditions that might cause adrenal haemorrhage

A
  • Antiphosholipid syndrome
  • SLE
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9
Q

What are the causes of secondary adrenal insufficiency?

A
  • Iatrogenic
  • Hypothalamic pituitary disease
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10
Q

How can secondary adrenal insufficiency be caused iatrogenically?

A

Due to long-term steroid therapy leading to suppression of the pituitary-adrenal axis

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11
Q

When does the suppression of the pituitary adrenal axis due to steroid therapy become apparent?

A

Only on the withdrawal of steroids

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12
Q

How does hypothalamic pituitary disease lead to secondary adrenal insufficiency?

A

Due to decreased ACTH production

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13
Q

What are the symptoms of adrenal insufficiency?

A
  • Lean and tanned appearance
  • Weakness
  • Anorexia
  • Dizziness and faints
  • Flu-like myalgia or arthralgia
  • Depression
  • Psychosis
  • Nausea and vomiting
  • Abdominal pain
  • Diarrhoea/constipation
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14
Q

How is adrenal insufficiency investigated?

A
  • Blood tests
  • Short ACTH stimulation test with Synacthen
  • ACTH
  • 21-Hydroxylase adrenal autoantibodies
  • Plasma renin and aldosterone
  • AXR/CXR
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15
Q

What is found on blood tests in adrenal insufficiency?

A
  • Decreased sodium and glucose
  • Increased potassium and calcium
  • Uraemia
  • Eosionphilia
  • Anaemia
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16
Q

How is a short ACH stimulation test carried out?

A

You do plasma cortisol before, and half an hour after, Synacthen 250mcg IM

17
Q

What does the result of a short ACTH stimulation test tell you?

A

Addison’s can be excluded if 30 min cortisol >550nmol/L

18
Q

What may confuse the result of a short ACTH stimulation test?

A
  • Steroid drugs
  • Pregnancy
  • Contraceptive pill
19
Q

What effect might steroid drugs have on short ACTH stimulation test?

A

They might interfere with assays, so have to confirm with lab

20
Q

What will be found on ACTH testing in Addison’s disease?

A

9am ACTH is inappropriately high, at >300ng/L

21
Q

What will be found on ACTH testing in secondary adrenal insufficiency?

A

9am ACTH is low

22
Q

How is adrenal insufficiency treated?

A
  • Glucocorticoid replacement
  • Mineralocorticoid replacement
  • Androgen replacement
  • Self-care advise
23
Q

What is used for glucocorticoid replacemet in adrenal insufficiency?

A

Hydrocortisone is usually used, but long-acting glucocorticoids such as prednisolone and dexametasone are sometimes used

24
Q

Why are longer acting glucocorticoids such as prednisolone and dexamethasone sometimes used in adrenal insufficiency?

A

To avoid the peaks and troughs which may occur with hydrocortisone

25
Q

What dose of hydrocortisone is given in adrenal insufficiency?

A

15-30mg per day

26
Q

What does the dose of hydrocortisone given in adrenal insufficiency depend on?

A
  • Body weight
  • Metabolism
  • Absorption
27
Q

How is the daily dose of hydrocortisone often given?

A

Three divided doses normally given (e.g. 10mg on waking, 10mg at noon, 5mg at night)

28
Q

Why are 3 divided doses of hydrocortisone usually given in adrenal insufficiency?

A

To best resemble the natural cycle of corticosteroid release

29
Q

What is used in mineralocorticoid replacement in adrenal insufficiency?

A

Fludrocortisone

30
Q

What dose of fludrocortisone is usually given in adrenal insufficiency?

A

50-300mg

31
Q

What does the dose of fludrocortisone given in adrenal insufficiency depend on?

A
  • Metabolism
  • Exercise levels
32
Q

What things should a person with Addison’s disease, and their families/carers, know?

A
  • The need for lifelong glucocorticoid replacement, and the potentially life-threatening complications which may arise with inadequate treatment, especially at times of illness and physical stress
  • How to adjust steroid medication during times of illness
  • How to recognise symptoms of adrenal crisis, and how to give intramuscular hydrocortisone in an emergency
  • The importance of carrying emergency information on their person, including MedicAlert identification, steroid treatment card, and an emergency crisis letter

.0.0 RSP Endocrine (18 decks)

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