Addison's Disease Flashcards
Addison’s disease is also well known as…
Pathological
Primary adrenal insufficiency
Addison’s is a rare disorder, where…
The adrenal glands cannot synthesize enough glucocorticoids and mineralocorticoids
Destruction of all 3 zones of the adrenal glands
Addison’s is most commonly caused by…
Autoimmune mediated destruction of the adrenal cortex
Infectious disease could cause, tumours, hemorrhage, etc.
Injury to the adrenal glands
Secondary adrenal insufficiency most commonly occurs in people who are…
Taking chronically administered exogenous corticosteroids
Due to abrupt withdrawal of CS; HPA axis suppression
Other causes include tumours, surgical removal of pituitary
A good method to remember the signs and symptoms of Addison’s, is…
Lack of cortisol - opposite of Cushing’s, or too much cortisol/corticosteroid
Some symptoms resulting from glucocorticoid deficiency are…
Fatigue, weight loss, N/V, diffuse pain
Hypotension + depression
Some symptoms resulting from mineralocorticoid + androgen deficiency are…
Dehydration
Hypotension - postural
Low libido
Salt cravings
A symptom that often precedes other symptoms by months to years in adrenal insufficiency is…
Hyperpigmentation
Hyperpigmentation in adrenal insufficiency is caused by…
High levels of ACTH that bind to melanocortin 1 receptor, on surface of dermal melanocytes
Lab values that are abnormal with adrenal insufficiency include…
Hyponatremia, Hyperkalemia
Hypoglycemia, mild anemia, elevated creatinine/BUN
Neutropenias
ALSO CHECK cortisol levels
Diagnosis of primary/secondary adrenal insufficiency is based on…
Clinical presentation (persistent vague symptoms)
Lab Tests - cortisol levels
Medical imaging
Other endocrine disorders are common
Treatment of chronic adrenal insufficiency requires…
Daily glucocorticoid and mineralocorticoid replacement
Hydrocortisone is the drug of choice for glucocorticoids, because…
HC has most potent mineralcorticoid activity compared to other glucocorticoids.
Dose adjustments of glucocorticoids are made based on…
Patient well-being; signs and symptoms, such as BP, weight, hyperpigmentation
Usually started @ HC 15-30 mg/day, BID/TID with most of dose in AM
The most commonly used mineralcorticoid used is…
Fludricortisone
Mineralocorticoid dosing is adjusted based on…
Blood pressure, sodium and potassium levels
Supplemental stress dosing refers to…
Why and when would we do this?
Usage of glucocorticoids during strenuous activities/events, to compensate for cortisol release during stress periods
Strenuous exercise, minor febrile illness/trauma
VERY IMPORTANT !!!!
If low libido is also present despite CS treatment, what else could be considered?
Trial of DHEA
DHEA may result in some adverse effects, such as…
Sweat odour, acne, hirsutism, itchy scalp
Acute adrenal crisis can be caused by…
Anything that increases adrenal requirements, especially in underlying deficiency
Most occur by abrupt steroid withdrawal, or not enough stress dose
Signs and symptoms of acute adrenal crisis are indicative of gluco+mineralocorticoid deficiency, such as…
Severe N/V, anorexia
Dehydration, fever, tachycardia
Hypoglycemia
Deteriorating mental status, biochemical changes
Hypotension unresponsive to vasopressors
Treatment of acute adrenal crisis involves the following…
Parenteral glucocorticoids (HC for combined gluco + mineralo activity)
Fluid replacement
Fludricortisone when patient can eat/drink, with HC dose decreased
An example of hydrocortisone dosing in acute adrenal crisis is…
300mg HC IV over 24 hours for 2-3 days, then dose decrease over next week to daily oral replacement doses
Signs of undertreatment of adrenal insufficiency are…
Symptom recurrence, or nonspecific symptoms
