Addisons Flashcards
What is adrenal insufficiency?
Adrenal insufficiency is where the adrenal glands do not produce enough steroid hormones, particularly cortisol and aldosterone
What is primary adrenal insufficiency?
Addisons disease
Adrenal glands are damaged usually autoimmune
What is secondary adrenal insufficiency?
inadequate adrenocorticotropic hormone (ACTH) and a lack of stimulation of the adrenal glands, leading to low cortisol.
○ This is the result of loss or damage to the pituitary gland.
○ Secondary adrenal insufficiency can be due to:
§ Tumours (e.g., pituitary adenomas)
§ Surgery to the pituitary
§ Radiotherapy
§ Sheehan’s syndrome = where major post-partum haemorrhage causes avascular necrosis of the pituitary gland
§ Trauma
What is sheehans syndrome?
where major post-partum haemorrhage causes avascular necrosis of the pituitary gland
What is tertiary adrenal insufficiency?
inadequate corticotropin-releasing hormone (CRH) release by the hypothalamus.
○ Usually the result of patients taking long-term oral steroids (for more than 3 weeks), causing suppression of the hypothalamus (via negative feedback)
What are the treatments of adrenal insufficiency? (2)
• Hydrocortisone 15-30mg/day divided into doses(a glucocorticoid) is used to replace cortisol.
• Fludrocortisone 50-300mcg/day (a mineralocorticoid) is used to replace aldosterone, if aldosterone is also insufficient.
What happens to steroids in illness?
Doses are doubled during an acute illness to match the normal steroid response to illness.
What are the signs of adrenal crisis? (5)
• Reduced consciousness
• Hypotension
• Hypoglycaemia
• Hyponatraemia
hyperkalaemia
What are the electrolyte disturbances in adrenal crisis? (2)
Hyponatraemia
Hyperkalaemia
What is the management of an adrenal crisis?
• ABCDE approach to initial assessment and arrange transfer to hospital
• Intramuscular or intravenous hydrocortisone (the initial dose is 100mg, followed by an infusion or 6 hourly doses)
• Intravenous fluids
• Correct hypoglycaemia (e.g., IV dextrose)
• Careful monitoring of electrolytes and fluid balance
What is the main medication given in an adrenal crisis?
• Intramuscular or intravenous hydrocortisone (the initial dose is 100mg, followed by an infusion or 6 hourly doses)
What are the symptoms of adrenal insufficiency? (10)
• Fatigue
• Muscle weakness
• Muscle cramps
• Dizziness and fainting
• Thirst and craving salt
• Weight loss
• Abdominal pain
• Depression
• Reduced libido (mainly in women)
• Loss of hair in axillary/pubic regions (mainly in women)
What are the signs of adrenal insufficiency? (2)
Bronze hyperpigmentation
Hypotension
What are the levels of acth in primary adrenal insufficiency?
High
What is the acth level in secondary and tertiary adrenal failure?
Low
