ACTH, Cortisol and Aldosterone

Question 1

What is a common cause of adrenal crisis?

Answer 1

Acute withdrawal of steroids, especially in patients with long term steroid use.

Question 2

What is the most common symptom of Addison’s disease?

Answer 2

Fatigue

Question 3

What are the causes of death in Adrenal crisis?

Answer 3

Death may be caused by circulatory collapse and arrhythmias with hypoglycaemia contributing.

Question 4

Why is Addison’s disease considered/suspected as a differential in patients diagnosed with T1DM, but has recurrent unexplained bouts of hypoglycaemic attacks?

Answer 4

Cortisol helps increase glucose by promoting gluconeogenesis in the liver. In Addison’s disease/Adrenal insufficiency, there is low cortisol levels.
In addition, both T1DM and Addison’s disease presents with weight loss, fatigue and thirst.

Question 5

Why specialist advice is to be sought before doing a serum cortisol test for those on oestrogen treatment?

Answer 5

Oestrogen increases the hepatic production of cortisol-binding globulin, which can increase cortisol levels

Question 6

What are the precipitating factors of Adrenal Crisis?

Answer 6

Acute illness, Injury, Sudden withdrawal of steroids, major or minor infections (especially those causing Vomiting and Diarrhoea), Pregnancy