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Endocrine > 2: Adrenal Insufficiency > Flashcards

2: Adrenal Insufficiency Flashcards

1
Q

What is adrenal insufficiency

A

Failure adrenal medulla to produce sufficient glucocorticoid and mineralocorticoid hormone

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2
Q

What is primary adrenal insufficiency called

A

Addison’s disease

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3
Q

What is the most common cause of primary adrenal insufficiency in the UK

A

Autoimmune (Addison’s)

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4
Q

what is the most common cause of primary adrenal insufficiency worldwide

A

TB

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5
Q

what are 3 other causes of adrenal insufficiency

A
  • Adrenal metastases (Breast, Lung, Renal)
  • Lymphoma
  • HIV: mycobacterium avium
  • Waterhouse-Freidrichson
  • Antiphospholipid syndrome
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6
Q

what cancers may metastasise to the adrenal glands

A

Liver
Lung
Breast
Lymphoma

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7
Q

when does waterhouse-freidrichson typically occur

A

Post TB

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8
Q

what are secondary adrenal insufficiency disorders

A

Iatrogenic - long-term steroid-use which suppress the HPA axis

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9
Q

how can primary and secondary adrenal insufficiency be identified clinically

A

Primary will cause hyperpigmentation of the skin. This is due to increase in ACTH to try and increase adrenal hormone secretion, with excess being converted to melanin.

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10
Q

what is the problem with diagnosing addisons disease

A

Non-specific symptoms often leads to a late diagnosis

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11
Q

what are general symptoms of Addison’s disease

A
  • Weak
  • Lethargy
  • Fatigue
  • Anorexia
  • Postural hypotension
  • Flu-like
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12
Q

what are mood symptoms of addison’s disease

A

Tearful
Psychosis
Depression

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13
Q

what are GI symptoms of Addison’s disease

A

Abdominal pain and vomiting

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14
Q

what are skin symptoms of Addisons disease

A

Hyperpigmentation (primary)

Vitiligo

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15
Q

what investigations are ordered in adrenal insufficiency

A
  • Capillary Blood Glucose
  • U+E
  • Synacthen test
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16
Q

how will capillary blood glucose present

A

Low: due to cortisol deficiency

17
Q

how will U+E present and why

A

Hyponatraemia, Hyperkalaemia.

Aldosterone usually causes re-absorption of sodium for potassium. Therefore deficiency will result in sodium excretion.

18
Q

what is the diagnostic test for adrenal insufficiency

A

Synacthen test (Short ACTH stimulation test)

19
Q

explain synacthen test

A

Give IM synacthen and 30m later measure cortisol

20
Q

what result in synacthen test confirms Addison’s disease

A

A rise in cortisol >550, excludes Addison’s disease

21
Q

when may synacthen test not be reliable and why

A

Pregnancy and COCP - due to increased concentration of cortisol binding globulin which gives falsely high cortisol levels

22
Q

what antibodies are present in 80% of Addison’s

A

21-OH adrenal autoantibodies (80%)

23
Q

when is a AXR and CXR important in primary adrenal insufficiency

A

Check for fibrosis due to TB

24
Q

what is given in adrenal insufficiency

A
  • Hydrocortisone

- Fludrocortisone

25
Q

if febrile illness or injury what should happen to hydrocortisone

A

Double hydrocortisone

26
Q

what is the main complication of primary adrenal inusfficiency

A

addisonian crisis

27
Q

what is addisonian crisis

A

acute exacerbation of addison’s disease

28
Q

what are 5 causes of addisonian crisis

A
  • Sudden cessation of glucocorticoids in patients with long-term use
  • Sepsis
  • Surgery
  • Stress in adrenal insufficiency patient
  • Pituitary apoplexy
29
Q

what is fulminant meningococcaemia

A

Waterhouse-Freidrichson syndrome

30
Q

what is pituitary apoplexy

A

Sudden decrease in pituitary function

31
Q

how does addison’s disease present clinically

A
  • Coma
  • Shock: hypotension, tachycardia
  • Fever
  • Severe abdominal pain
  • Vomiting and diarrhoea
32
Q

what are the electrolyte abnormalities in Addison’s disease

A
  • Hyperkalaemia
  • Hyponatraemia
  • Metabolic acidosis
  • Low glucose
33
Q

explain pH and potassium state

A

(H)igh potassium is associated with (H)+ = metabolic acidosis

34
Q

explain investigations in addisonian crisis

A

Do not wait for results of investigations to treat

35
Q

what investigations are ordered

A 
ABG
U+E
ECH
Serum Glucose 
Random Plasma Cortisol
36
Q

what may be seen on ABG

A

Hyperkalemia, Hyponatraemia, Metabolic acidosis

37
Q

what may be seen on ECG

A

Tall tented T waves
Loss of P waves
Broad QRS

38
Q

explain how addisonian crisis is managed

A

IV (or IM) Hydrocortisone (100mg)

1L 0.9% NaCl

39
Q

how long should hydrocortisone be continued for

A

Continue 6hrly until patient stable. Usually after 24h switch to oral for 4-6 days

Endocrine (20 decks)

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