Addisons disease Flashcards
what does destruction of the adrenal cortex lead to
glucocorticoid and mineralocorticoid deficiency
what is an example of a glucocorticoid
cortisol
example of mineralocorticoid
aldosterone
causes
80% autoimmunity, TB, adrenal metastases, lymphoma, HIV, congenital
symptoms
lean, tanned, tired, weak, anorexia, dizzy, faints,. depression, psychosis, nausea, vomiting, abo pain, diarrhoea, constipation
what test can be done
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
what happens to Na, K and glucose, why
Na down, K up due to decreased mineralocorticoid. glucose decr due to decreased cortisol
treatment
replace steroids- hydrocortisone, fludrocortisone
what is the commonest cause of secondary adrenal insufficiency
iatrogenic- long term steroid use. other causes rare- hypothalamic disease leading to decreased ACTH production.
what are the signs and symptoms of an Addisonian crisis
in shock- incr pulse, vasoconstriction, postural hypotension, oliguria, weak, confused, comatose
precipitating factors crisis
infection, trauma, surgery, missed medication
management crisis
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
continuining treatment in crisis
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.
