Addisons disease Flashcards

1
Q

what does destruction of the adrenal cortex lead to

A

glucocorticoid and mineralocorticoid deficiency

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2
Q

what is an example of a glucocorticoid

A

cortisol

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3
Q

example of mineralocorticoid

A

aldosterone

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4
Q

causes

A

80% autoimmunity, TB, adrenal metastases, lymphoma, HIV, congenital

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5
Q

symptoms

A

lean, tanned, tired, weak, anorexia, dizzy, faints,. depression, psychosis, nausea, vomiting, abo pain, diarrhoea, constipation

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6
Q

what test can be done

A

synacthen test- plasma cortisol before and half an hourafter tetracosactide. exclude if cortisol >550nmol/l. (short ACTH stimulating test); 9am ACTH is inappropriately high; 21-hydroxylase adrenal autoantibodies (positive in auto immune); plasma renin and aldosterone

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7
Q

what happens to Na, K and glucose, why

A

Na down, K up due to decreased mineralocorticoid. glucose decr due to decreased cortisol

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8
Q

treatment

A

replace steroids- hydrocortisone, fludrocortisone

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9
Q

what is the commonest cause of secondary adrenal insufficiency

A

iatrogenic- long term steroid use. other causes rare- hypothalamic disease leading to decreased ACTH production.

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10
Q

what are the signs and symptoms of an Addisonian crisis

A

in shock- incr pulse, vasoconstriction, postural hypotension, oliguria, weak, confused, comatose

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11
Q

precipitating factors crisis

A

infection, trauma, surgery, missed medication

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12
Q

management crisis

A

bloods for cortisol and ACTH. U & E. if high K+ give calcium gluconate, if low Na+ resolve with rehydration and steroids. hydrocortisone 100mg IV. IV fluid blous crystalloid or colloid. BM- danger is hypoglycaemia. blood, urine, sputum for culture

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13
Q

continuining treatment in crisis

A

glucose IV if hypo, IV fluids and correct U & E imbalance, continue hydrocortisone 100mg/8h, change to oral steroids after 72h if condition ok. fludrocortisone needed if cause is adrenal disease.

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