Addison's Disease (adrenal insufficiency) Flashcards
What is Addison’s Disease?
When adrenal glands are damaged so don’t produce enough steroid hormones (cortisol + aldosterone)
What order Adrenal Insufficiency is Addison’s?
Primary Adrenal Insufficiency
What is Secondary Adrenal Insufficiency?
Low ACTH –> low adrenal gland stimulation –> low cortisol release
Problem is in Pituitary gland not adrenal gland
What are the causes of Secondary Adrenal Insufficiency? (4 things)
Loss / damage to pituitary gland bc:
- Surgery to remove pituitary tumour
- Infection
- Loss of blood flow
- Radiotherapy
What is Tertiary Adrenal Insufficiency?
Loss of CRH release from hypothalamus –> pituitary doesn’t release ACTH –> adrenal gland doesn’t release cortisol
What causes Tertiary Adrenal Insufficiency?
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
What steroids are clarted in Primary Adrenal Insufficiency (aka Addison’s)?
All 3 (glucocorticoids + mineralcorticoids + androgens)
What steroids are clarted in Secondary + Tertiary Adrenal Insufficiency?
Jus glucocorticoids + adrogens
(Mineralcorticoids are preserved)
What are the CF of Glucocorticoid deficiency in Adrenal Insufficiency? (6 things)
- Fatigue
- Nausea
- Abd pain
- Hypotension (esp postural)
- Hypoglycaemia
- Weight loss
What are the CF of Mineralcorticoid deficiency in Adrenal Insufficiency? (4 things)
NB?
- Hypotension
- Salt craving
- Hyperkalaemia
- Hyponatraemia
NB: These don’t happen in Secondary + Tertiary Adrenal Insufficiency bc Mineralcorticoids preserved in dem
What are the CF of Androgens deficiency in Adrenal Insufficiency? (3 things)
- Reduced libido
- Less axillary + pubic hair
- Amenorrhoea
Why is ACTH high in Primary Adrenal Insufficiency?
Because low cortisol –> -ve fdbk –> Pituitary releases more ACTH
What CF is caused by high ACTH in Primary Adrenal Insufficiency?
Bronze hyperpigmentation of skin
What investigations should you do for sus Adrenal Insufficiency? (7 things)
- Short synacthen test (GOLD)
- UnEs (Hyponatraemia + Hyperkalaemia)
- Glucose
- Morning cortisol
- ACTH levels
- Adrenal antibodies (bc main cause of Primary is AI)
- CT / MRI
What does a Short Synacthen test tell you? (GOLD STANDARD)
- Primary = NO increase in cortisol* (bc adrenal glands r clarted)
- 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
What will UnEs show you in Adrenal Insufficiency? (2 thing)
- Hyponatraemia
- Hyperkalaemia
What will glucose be in Adrenal Insufficiency?
Low bc low cortisol
What will a Morning cortisol test show you in sus Adrenal Insufficiency?
Low cortisol = highly sus Adrenal Insufficiency
(but often falsely normal)
What will the ACTH levels show in sus Adrenal Insufficiency?
Primary = high bc -ve fdbk of low cortisol
Seconary + Tertiary = low bc pituitary / hypothalamus clarted
What are the Adrenal antibodies (present in 80% of AI Adrenal Insufficiency)? (2 things)
- Adrenal cortex antibodies
- 21-hydroxylase antibodies
When should you do a CT / MRI in Adrenal Insufficiency? (4 things)
- CT / MRI adrenal if sus:
- Adrenal tumour
- Haemorrhoage
- Other structural pathology
- MRI pituitary for:
1. More info abt pituitary pathology
What is the treatment for Adrenal Insufficiency? (2 things)
Steroid replacement
- Hydrocortisone (to replace cortisol)
- Fludrocortisone (to replace aldosterone)
What should you do when a person with diagnosed Adrenal Insuffiency gets acutely ill?
Double steroid doses till der better
What is an Addisonian Crisis?
Steroid abscence –> life threatening presentation
When can an Addisonian Crisis present? (3 things)
- First presentation of undiagnosed Addison’s
- Triggered by infection / trauma / acute illness
- After withdrawing long term steroids
What are the CF of Addisonian Crisis? (5 things)
- Reduced consciousness
- Hypotension
- Hypoglycaemia
- Hyponatraemia + hyperkaemia
- Very unwell
What should you do immediately in a sus Addisonian Crisis?
Treat immediately bc life threatening
Don’t bother doing investigations n diagnosis n dem tings
How do you manage an Addisonian Crisis? (5 things)
- Intensive monitoring
- Parenteral* steroids (IV hydrocortisone 100mg stat, then 100mg every 6 hrs)
- IV fluids
- Correct hypoglycaemia
- Correct electrolye abn
Parenteral = anywhere but da mouth
