Addison's (Adrenal insufficiency) Flashcards
What is addison’s
Primary adrenal insufficiency caused by adrenal cortex damage decreasing glucocorticoid production
What are the causes of Addison’s
Auto immune (UK Common)
TB (World Common)
Waterhouse freiderichsen hemorrhage
Adrenal resection
What causes secondory adrenal insufficency
Supressed HPA axis
Congenital
adrenal metastasis
adrenal haemorrhage
radiotherapy and surgery
What are the RF of Addison’s
Female
Adrenocortical antibodies
Autoimmune diseases
What are the signs of Addison’s
Hyperpigmentation (Increase melanocytes)
Postural Hypotension
Syncope and malaise
Vitiligo
What are the electrolyte imbalances for Addison’s
Low sodium High Potassium Low glucose Low cortisol High Renin Low Aldosterone
How do you confirm diagnosis of Addison’s (GOLD)
Short Synacthen test
- Measure cortisol at 9am
- Give synthetic ACTH
- Measure after 30 mins
How do you investigate Addison’s
Bloods Adrenal auto-antibodies Chest Xray Adrenal gland CT Brain MRI
What is the treatment of Addison’s
Glucocorticoid replacement
(Hydrocortisone) double for infection and trauma
Mineralocorticoid replacement
(Fludrocortisone)
How to treat an Adrenal Crisis
Aggressive fluid resuscitation
IV Hydrocortison
Glucose for hypoglycemia
What is Waterhouse Friederichsen (Fatal)
DIC and Adrenal hemorrhage caused by severe bacterial infection (N. Meningitidis)
Present with infection, purpura with septic shock
What is the first line investigation for Addison’s
Morning serum cortisol
What is the pathology of Addison’s
Destroyed adrenal cortex
Increase ACTH
Stimulated Melanocytes = Hyperpigmentation
What is the pathology of secondary Adrenal insufficency
HPA suppression
Decrease ACTH w/ no hyperpigmentation
What SynACTHen result excludes Adisson’s
Plasma cortisol >580
