Addisons

Question 1

see notes

Answer 1

y3 paper

Question 2

presentation?

Answer 2

acute or insidious,

with substantial fatigue and weakness associated with mucocutaneous hyperpigmentation,

hypotension and/or postural hypotension, and salt craving

Question 3

aetiology

Answer 3

Primary:

1. autoimmune
2. TB

Secondary;
Insuficient pitutary ACTH

Tertiary;
No Hypothalamic CRH

-> Adrenal cortex hormones low; cortisol and aldosterone

Question 4

ivx

Answer 4

1. 9am cortisol - above 276 is nomral
2. syncathen test - below 497 at 30 mins is Addisons
3. FBC, UEs - low NA high K
4. low aldosterone, high renin

Question 5

mx?

Answer 5

Crisis;

• Glucocorticoid (Hydrocortisone IV/IM) 3 days
• Fluid resus
• Endo input

Ongoing;

• glucocorticoid + mineralocorticoid;
• Hydro PO + fludrocortisone PO

Question 6

causes of addisonian crisis?

Answer 6

stopping glucocorticoids abruptly

patients with addisons that become ill/surgery/trauma - they hormones dont adjust