Addisons disease Flashcards

1
Q

What causes addisons disease

A

Lack of aldosterone and coritisol
primary hypoadrenalism

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2
Q

Why does addisons cause bronzed skin and where is the first place its seen

A

Melanin production from ACTH excess
First place seen is the gums

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3
Q

What treat addisonian crisis with

A

Hydrocortisone IV + fluids

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4
Q

What is an acute adrenal crisis

A

hypovolaemic shock as no pressure from adrenergic receptors
Hypoglycaemia

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5
Q

What electrolyte imbalance is seen in addisons

A

Acidosis - hyperkalmaeia

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6
Q

What need to check before giving levothyroxine

A

Cortisol levels - levothyrozine increases cortisol metabolism - can send into addisonian crisis

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7
Q

Cortisol function

A
  • Blood sugar regulation
  • BP control
  • Antinflammatory effects
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8
Q

What is addisons disease

A

Primary adrenal insuffiency -> lack of aldosterone and cortisol due to destruction of adrenal cortex
Excess ACTH

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9
Q

Causes of addisons

A

Autoimmune
TB - most common globallu
Adrenal metastasis
Bilateral adrenalectomy
Adrenal haemorrhage
Infections
Genetic conditions
pROLONGED use of glucocorticids or drugs inhibiting steroid production eg ketoconazole supress HPA axis -> adrenal atrophy and insufficiency

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10
Q

Infections that can cause addisons

A

histoplasmosis, crytpococcosis, CMV, HIV

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11
Q

Genetic conditions causing addisons

A

Amyloidosis and haemochromatosis
Congenital adrenal hyperplasia
Congenital or neonatal primary adrenal insuffficiency - CYP21A2, AIRE 9APS-1)

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12
Q

Why is there excess of ACTH in addisons disease

A

Lack of aldosterone and cortisol stimualtes release but cortex cant respond to ACTH due to destruction

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13
Q

Prognosis of addisons

A

20-30 yr old women more common
If untreated always fatal
Require lifelong treatment, premature risk of death

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14
Q

Clinical features of addisons

A

Weight loss
Anorexia
Slat cravings
Malaise + easy fatiguabilit
Weakness
Fever
Depression
Impotence/amenorrhea
N+V
Diarrhoea Confusion
Syncope
Abdo pin
Constipation
Myalgia
Joint or back pain

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15
Q

Signs of addisons disease

A

New scars, palmar crease pigementation
Buccal pigmentation
Postural hypotension
Weight loss
General
Dehydration
Loss of body hair
Vitilifo

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16
Q

WHat causes pigmentation in addisos

A

POMC -> increased Melanocyte StimHoromne - dark skin

17
Q

Electrolytes in addisons

A

Hyponatermia
Hyperkalemia
Metabolic acidosis

18
Q

How do a short synacthen test

A

Cortisol at 0 minutes - gie ACTH 250mg
Cortisol level at 30+60 mins

19
Q

What result from short synacthen test diangoses addisons

A

<500 at 30 or 60 mins

20
Q

When should short synacthen test be perfrmed

A

18-24 hours after last steroid dose

21
Q

Management of addisons

A

Gluco and mineralcorticoid replacement
Glucocorticoid replacement - hydrocortisone, prednisolone, dexamethasone
Mineralcorticoid replacement - fludrocortisone

22
Q

When do yuo double glucocortiocids taken in addisons

A

unwell - moderate fever, infection with antibiotics, local anaesthetis

23
Q

What causes an addisonian crisis

A

Lack of steroids - first presentation of addisons or not enough steroids given, taken, retained etc

24
Q

Clinical features of addisons

A

Fatigue, weight loss, no energy
Hypotnesion 0 dizzym collapse, shok
Abdo pain - tender, guarding, N+V
Fever
Confusion - somnolence, delirium, coma
Back and leg cramps

25
Biochem results in addiosnian crisis
Hyponatermia hyperkaelmia Hypoglycaemia Pre renal failure
26
Investigations in addisons cirsis
Cortiosl, U+Es, TFTs, ACTH, FBC BP Drug hisory #Dont wait to treat if sus
27
Treatment of addisonian crisis
IV bolus of 100mg IV hydrocortisone Cont 200mg IV hydro per 24 hours, or 50mg every 6 Rehydration - rapid 1000ml first hour
28
When give hydrocortisone IV 100mg in addisons
Severe illness eg persistent vomitting, prep for colonosopy, acute trauma or surgery any major stressors
29
What give in adrenal crisis initially
IM hydrocortisone - 100mg emergency it
30
Why is it important to treat an addisonian crisis so quickly
Hypovolaemia -> ischamia and end organ damage Death
31
What 9amcortiisol level would make addisons more or less liely
>500 - v unlikely <100 = v abnormal 100-500 - > ACTH stim tst
32
What antibpdies can be seen in addisons
anti-21-hydroxylase
33
What need to monitor in addisons
Osteoporosis due to long term steroid use - DEXA scans and give vit D
34
Addisons definitive investiation
ACTH stimulation test - short synacthen test
35
How is ACTH test done
PLasma cortisol measred before and 30 mins after 250ug IM stnacthen
36
Management addisons crisis
hydrocortisone 100 mg im or iv 1 litre normal saline infused over 30-60 mins or with dextrose if hypoglycaemic continue hydrocortisone 6 hourly until the patient is stable. oral replacement may begin after 24 hours and be reduced to maintenance over 3-4 days