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Corticosteroids > Addison's Disease > Flashcards

Addison's Disease Flashcards

1
Q

Addison’s disease is also well known as…

Pathological

A

Primary adrenal insufficiency

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2
Q

Addison’s is a rare disorder, where…

A

The adrenal glands cannot synthesize enough glucocorticoids and mineralocorticoids

Destruction of all 3 zones of the adrenal glands

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3
Q

Addison’s is most commonly caused by…

A

Autoimmune mediated destruction of the adrenal cortex

Infectious disease could cause, tumours, hemorrhage, etc.

Injury to the adrenal glands

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4
Q

Secondary adrenal insufficiency most commonly occurs in people who are…

A

Taking chronically administered exogenous corticosteroids

Due to abrupt withdrawal of CS; HPA axis suppression

Other causes include tumours, surgical removal of pituitary

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5
Q

A good method to remember the signs and symptoms of Addison’s, is…

A

Lack of cortisol - opposite of Cushing’s, or too much cortisol/corticosteroid

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6
Q

Some symptoms resulting from glucocorticoid deficiency are…

A

Fatigue, weight loss, N/V, diffuse pain
Hypotension + depression

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7
Q

Some symptoms resulting from mineralocorticoid + androgen deficiency are…

A

Dehydration
Hypotension - postural
Low libido

Salt cravings

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8
Q

A symptom that often precedes other symptoms by months to years in adrenal insufficiency is…

A

Hyperpigmentation

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9
Q

Hyperpigmentation in adrenal insufficiency is caused by…

A

High levels of ACTH that bind to melanocortin 1 receptor, on surface of dermal melanocytes

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10
Q

Lab values that are abnormal with adrenal insufficiency include…

A

Hyponatremia, Hyperkalemia
Hypoglycemia, mild anemia, elevated creatinine/BUN
Neutropenias

ALSO CHECK cortisol levels

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11
Q

Diagnosis of primary/secondary adrenal insufficiency is based on…

A

Clinical presentation (persistent vague symptoms)
Lab Tests - cortisol levels
Medical imaging

Other endocrine disorders are common

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12
Q

Treatment of chronic adrenal insufficiency requires…

A

Daily glucocorticoid and mineralocorticoid replacement

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13
Q

Hydrocortisone is the drug of choice for glucocorticoids, because…

A

HC has most potent mineralcorticoid activity compared to other glucocorticoids.

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14
Q

Dose adjustments of glucocorticoids are made based on…

A

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

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15
Q

The most commonly used mineralcorticoid used is…

A

Fludricortisone

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16
Q

Mineralocorticoid dosing is adjusted based on…

A

Blood pressure, sodium and potassium levels

17
Q

Supplemental stress dosing refers to…

Why and when would we do this?

A

Usage of glucocorticoids during strenuous activities/events, to compensate for cortisol release during stress periods

Strenuous exercise, minor febrile illness/trauma

VERY IMPORTANT !!!!

18
Q

If low libido is also present despite CS treatment, what else could be considered?

A

Trial of DHEA

19
Q

DHEA may result in some adverse effects, such as…

A

Sweat odour, acne, hirsutism, itchy scalp

20
Q

Acute adrenal crisis can be caused by…

A

Anything that increases adrenal requirements, especially in underlying deficiency

Most occur by abrupt steroid withdrawal, or not enough stress dose

21
Q

Signs and symptoms of acute adrenal crisis are indicative of gluco+mineralocorticoid deficiency, such as…

A

Severe N/V, anorexia
Dehydration, fever, tachycardia
Hypoglycemia
Deteriorating mental status, biochemical changes
Hypotension unresponsive to vasopressors

22
Q

Treatment of acute adrenal crisis involves the following…

A

Parenteral glucocorticoids (HC for combined gluco + mineralo activity)
Fluid replacement
Fludricortisone when patient can eat/drink, with HC dose decreased

23
Q

An example of hydrocortisone dosing in acute adrenal crisis is…

A

300mg HC IV over 24 hours for 2-3 days, then dose decrease over next week to daily oral replacement doses

24
Q

Signs of undertreatment of adrenal insufficiency are…

A

Symptom recurrence, or nonspecific symptoms

25
Q

Signs of overtreatment of adrenal insufficiency are…

A

Too much cortisol symptoms
Ex: weight gain, hyperglycemia, hypertension, other nonspecific symptoms

Corticosteroids (5 decks)

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