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Year 2 - endocrine > Addisons + secondary adrenal Insufficiency > Flashcards

Addisons + secondary adrenal Insufficiency Flashcards

1
Q

Most common cause of primary adrenal insufficiency?

A

Autoimmune adrenalitis

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2
Q

What are the Infectious causes of adrenal insufficiency?

A

TB, CMV, HIV

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3
Q

What are the cancer types that metastasise to the adrenal glands?

A

Lung, breast carcinoma

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4
Q

Name the condition with adrenal haemorrhage in sepsis?

A

Waterhouse-Friderichsen syndrome

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5
Q

Why does Addison’s cause hyperpigmentation?

A

Excess ACTH → excess MSH

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6
Q

Electrolyte imbalances in Addison’s?

A

↓ Na+
↑ K+
acidosis, hypoglycemia

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7
Q

Why does Addison’s cause salt craving?

A

Low aldosterone → Na+ loss

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8
Q

Key symptoms of Addison’s?

A

(1) Weakness
(2) Fatigue
(4) Weight loss
(5) N+V
(6) Low BP
(7) Abdominal pain

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9
Q

What are the signs of hyperpigmentation?

A

Tanned skin, dark buccal mucosa, palmar creases

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10
Q

1st-line test for Addison’s?

A

Short Synacthen test

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11
Q

ACTH & aldosterone levels in Addison’s?

A

↑↑ ACTH
↓ aldosterone
↑↑ renin

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12
Q

When should Addison’s be suspected in blood tests?

A

Hyponatremia + hyperkalemia

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13
Q

What is used for cortisol replacement?

A

Hydrocortisone

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14
Q

What is used for aldosterone replacement?

A

Fludrocortisone

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15
Q

Why must steroids not be stopped suddenly?

A

Risk of adrenal crisis

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16
Q

What are the “sick day rules”?

A

increase steroid replacement when unwell or undergoing other stress

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17
Q

What is the 1st-line test for Addison’s disease?

A

Short Synacthen Test
= checks ACTH response

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18
Q

How is the Short Synacthen Test performed?

A

Measure plasma cortisol before and 30 mins after IV/IM ACTH injection

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19
Q

What is a normal cortisol response in the Short Synacthen Test?

A

(1) Baseline >250 nmol/L
(2) Post-ACTH >550 nmol/L

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20
Q

What is secondary adrenal insufficiency?

A

Lack of ACTH production by the pituitary gland
= ↓ cortisol

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21
Q

What is tertiary adrenal insufficiency?

A

Lack of CRH secretion by the hypothalamus
= ↓ ACTH → ↓ cortisol

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22
Q

What is the most common cause of secondary/tertiary adrenal insufficiency?

A

Iatrogenic
(long-term exogenous steroid use)
(1) → suppresses CRH & ACTH
(2) → adrenal atrophy

23
Q

What are the other causes of secondary adrenal insufficiency?

A

(1) Pituitary/hypothalamic tumors
(2) Surgery
(3) Radiotherapy

24
Q

How does iatrogenic steroid use cause adrenal insufficiency?

A

Chronic steroids inhibit CRH & ACTH
= Leading to adrenal atrophy

The adrenal glands fail to produce cortisol even if ACTH is given

25
Q

Why is aldosterone normal in secondary/tertiary adrenal insufficiency?

A

Aldosterone is regulated by RAAS, not ACTH, so it remains intact

26
Q

How does secondary/tertiary adrenal insufficiency differ from Addison’s disease?

A

(1) No hyperpigmentation (low ACTH)
(2) No salt craving
(3) normal aldosterone
(4) No hypotension or hyperkalemia

27
Q

Why is skin pale in secondary adrenal insufficiency?

A

No excess ACTH, so no MSH activation
= no hyperpigmentation

28
Q

What is the gold standard test used to diagnose secondary/tertiary adrenal insufficiency?

A

Insulin tolerance test
= checks cortisol response to hypoglycemia

29
Q

What test is used to differentiate between secondary and tertiary causes

A

CRH stimulation test

30
Q

What is the treatment for secondary/tertiary adrenal insufficiency?

A

Hydrocortisone
= Cortisol replacement

31
Q

Why is fludrocortisone not needed?

A

Aldosterone production is intact
= RAAS regulation

32
Q

What should happen to a patient’s normal dose of steroids whilst they are unwell?

A

They should be doubled during the course of the illness

33
Q

How is the diagnosis of Addison’s disease confirmed?

A

Short synacthen test

34
Q

What dose of IV Hydrocortisone should be administered acutely during an Addisonian crisis?

A

100mg IV

Which can be followed by 100mg IM 6 hourly

35
Q

What medication can be used to help the body retain salt?

A

Fludrocortisone

36
Q

What happens to potassium levels in Addison’s disease?

A

They go up (Hyperkalaemia)

37
Q

Which autoimmune dermatological condition is associated with Addison’s disease?

38
Q

What electrolyte abnormalities may you find in an Addisonian crisis?

A
  1. Hyponatraemia
  2. Hyperkalaemia
  3. Hypoglycaemia
  4. Hypercalcaemia
  5. Raised urea
39
Q

What is the best initial treatment of an Addisonian crisis?

A

IV fluids and IV steroids

40
Q

What is the name given to adrenal haemorrhage following meningococcal sepsis?

A

Waterhouse-Friedrichson syndrome

41
Q

What is the peak cortisol cut off value expected following a short synacthen test that you would expect in a person with normal adrenal gland function?
ie, what level of cortisol needs to be achieved to be over?

A

550 nmol/l

42
Q

What is the screening test for adreno-cortical insufficiency?

A

9AM cortisol

43
Q

Which type of steroid is used in the management of an Adrenal crisis?

A

Hydrocortisone

44
Q

For patients with known adrenal insufficiency, what medication should they keep on hand in case of emergency?

A

Ef-Cortisol injection

45
Q

low sodium name

A

hyponatremia

46
Q

high potassium name

A

hyperkalemia

47
Q

A 32-year-old woman presents with fatigue, weight loss and hyperpigmentation. Her blood pressure is low, and she has a craving for salty foods.

What is the initial investigation?

A

9am serum cortisol

48
Q

A 50-year-old woman attends A&E feeling unwell with gastroenteritis. She has a history of rheumatoid arthritis and is on maintenance Prednisolone 10mg OD which she has not been able to take for the last three days.

What general advice should be given with regards to steroids and intercurrent illness?

A

Double steroid dose

49
Q

A 63-year-old female presents to her GP with confusion, weakness and dizziness. On examination, it is noted that she is tanned. The GP suspects Addison’s disease.

What is the most likely underlying aetiology?

A

Autoimmune

50
Q

A 45-year-old man is treated for Addison’s disease with Hydrocortisone (replacement glucocorticoid) and Fludrocortisone (replacement mineralocorticoid)

In which part of the adrenal gland is the mineralocorticoid produced?

A

Zona glomerulosa

51
Q

A 42-year-old male presents to the GP feeling weak, tired and faint. On examination, the GP notes he appears tanned. His GP suspects Addison’s disease

What first-line investigation should be ordered next?

A

9AM cortisol

52
Q

A 75-year-old woman with a history of polymyalgia rheumatica is found collapsed by her partner. Her partner remarks that she is likely exhausted after her holiday

  1. Low sodium
  2. High potassium
  3. High urea
  4. Low fasting glucose

What is the most likely cause of her collapse?

A

Adrenal crisis

53
Q

What are meningococcal septicaemia symptoms?

Patient has Waterhouse-Friderichsen syndrome

A

(1) Rash
(2) Neck stiffness
(3) Headache
(4) Fever

54
Q

A 60-year-old man is brought to the emergency department with abdominal pain and vomiting. On assessment, he is confused and has a blood glucose level of 3.2mmol/L (normal range 3.5-5.5 mmol/L) and blood pressure of 80/56. He has a past medical history of Addison’s disease. The patient is treated urgently for an Addisonian crisis. His daughter is also with him and wants to know more about his condition.

An Addisonian crisis is caused by the body’s inability to produce which hormone?

Year 2 - endocrine (30 decks)

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