Addison's Disease (adrenal insufficiency)

Question 1

What is Addison’s Disease?

Answer 1

When adrenal glands are damaged so don’t produce enough steroid hormones (cortisol + aldosterone)

Question 2

What order Adrenal Insufficiency is Addison’s?

Answer 2

Primary Adrenal Insufficiency

Question 3

What is Secondary Adrenal Insufficiency?

Answer 3

Low ACTH –> low adrenal gland stimulation –> low cortisol release

Problem is in Pituitary gland not adrenal gland

Question 4

What are the causes of Secondary Adrenal Insufficiency? (4 things)

Answer 4

Loss / damage to pituitary gland bc:

1. Surgery to remove pituitary tumour
2. Infection
3. Loss of blood flow
4. Radiotherapy

Question 5

What is Tertiary Adrenal Insufficiency?

Answer 5

Loss of CRH release from hypothalamus –> pituitary doesn’t release ACTH –> adrenal gland doesn’t release cortisol

Question 6

What causes Tertiary Adrenal Insufficiency?

Answer 6

Long term steroid use –> causes hypothalamus to shut down bc not in use anymore

When long term steroids stopped –> hypothalamus doesn’t wake up fast enough

So need to wean down steroids if u wanna stop dem

Question 7

What steroids are clarted in Primary Adrenal Insufficiency (aka Addison’s)?

Answer 7

All 3 (glucocorticoids + mineralcorticoids + androgens)

Question 8

What steroids are clarted in Secondary + Tertiary Adrenal Insufficiency?

Answer 8

Jus glucocorticoids + adrogens

(Mineralcorticoids are preserved)

Question 9

What are the CF of Glucocorticoid deficiency in Adrenal Insufficiency? (6 things)

Answer 9

1. Fatigue
2. Nausea
3. Abd pain
4. Hypotension (esp postural)
5. Hypoglycaemia
6. Weight loss

Question 10

What are the CF of Mineralcorticoid deficiency in Adrenal Insufficiency? (4 things)

NB?

Answer 10

1. Hypotension
2. Salt craving
3. Hyperkalaemia
4. Hyponatraemia

NB: These don’t happen in Secondary + Tertiary Adrenal Insufficiency bc Mineralcorticoids preserved in dem

Question 11

What are the CF of Androgens deficiency in Adrenal Insufficiency? (3 things)

Answer 11

1. Reduced libido
2. Less axillary + pubic hair
3. Amenorrhoea

Question 12

Why is ACTH high in Primary Adrenal Insufficiency?

Answer 12

Because low cortisol –> -ve fdbk –> Pituitary releases more ACTH

Question 13

What CF is caused by high ACTH in Primary Adrenal Insufficiency?

Answer 13

Bronze hyperpigmentation of skin

Question 14

What investigations should you do for sus Adrenal Insufficiency? (7 things)

Answer 14

1. Short synacthen test (GOLD)
2. UnEs (Hyponatraemia + Hyperkalaemia)
3. Glucose
4. Morning cortisol
5. ACTH levels
6. Adrenal antibodies (bc main cause of Primary is AI)
7. CT / MRI

Question 15

What does a Short Synacthen test tell you? (GOLD STANDARD)

Answer 15

1. Primary = NO increase in cortisol* (bc adrenal glands r clarted)
2. Secondary / Tertiary = increase in cortisol (bc its da pituitary / hypothalamus that r clarted)

* = Cortisol should increase by more than double baseline if normal, if not = primary AI

Question 16

What will UnEs show you in Adrenal Insufficiency? (2 thing)

Answer 16

1. Hyponatraemia
2. Hyperkalaemia

Question 17

What will glucose be in Adrenal Insufficiency?

Answer 17

Low bc low cortisol

Question 18

What will a Morning cortisol test show you in sus Adrenal Insufficiency?

Answer 18

Low cortisol = highly sus Adrenal Insufficiency

(but often falsely normal)

Question 19

What will the ACTH levels show in sus Adrenal Insufficiency?

Answer 19

Primary = high bc -ve fdbk of low cortisol

Seconary + Tertiary = low bc pituitary / hypothalamus clarted

Question 20

What are the Adrenal antibodies (present in 80% of AI Adrenal Insufficiency)? (2 things)

Answer 20

1. Adrenal cortex antibodies
2. 21-hydroxylase antibodies

Question 21

When should you do a CT / MRI in Adrenal Insufficiency? (4 things)

Answer 21

• CT / MRI adrenal if sus:

1. Adrenal tumour
2. Haemorrhoage
3. Other structural pathology

• MRI pituitary for:
  1. More info abt pituitary pathology

Question 22

What is the treatment for Adrenal Insufficiency? (2 things)

Answer 22

Steroid replacement

1. Hydrocortisone (to replace cortisol)
2. Fludrocortisone (to replace aldosterone)

Question 23

What should you do when a person with diagnosed Adrenal Insuffiency gets acutely ill?

Answer 23

Double steroid doses till der better

Question 24

What is an Addisonian Crisis?

Answer 24

Steroid abscence –> life threatening presentation

Question 25

When can an Addisonian Crisis present? (3 things)

Answer 25

1. First presentation of undiagnosed Addison’s
2. Triggered by infection / trauma / acute illness
3. After withdrawing long term steroids

Question 26

What are the CF of Addisonian Crisis? (5 things)

Answer 26

1. Reduced consciousness
2. Hypotension
3. Hypoglycaemia
4. Hyponatraemia + hyperkaemia
5. Very unwell

Question 27

What should you do immediately in a sus Addisonian Crisis?

Answer 27

Treat immediately bc life threatening

Don’t bother doing investigations n diagnosis n dem tings

Question 28

How do you manage an Addisonian Crisis? (5 things)

Answer 28

1. Intensive monitoring
2. Parenteral* steroids (IV hydrocortisone 100mg stat, then 100mg every 6 hrs)
3. IV fluids
4. Correct hypoglycaemia
5. Correct electrolye abn

Parenteral = anywhere but da mouth