Adrenal Insufficiency

Question 1

What is adrenal insufficiency?

Answer 1

Where adrenal glands do not produce enough steroid hormones particularly cortisol & aldosterone

Question 2

Is adrenal insufficiency bad?

Answer 2

Yes, it’s life threatening

Question 3

What is Addison’s disease?

Answer 3

Specific condition where adrenal glands have been damaged resulting in reduction of secretion of cortisol & aldosterone

Question 4

What is Addison’s disease AKA?

Answer 4

Primary adrenal insufficiency

Question 5

What is the most common cause of Addison’s disease?

Answer 5

AI

Question 6

What is secondary adrenal insufficiency?

Answer 6

Result of inadequate ACTH stimulating adrenal glands resulting in low cortisol release, occurring as a result of loss or damage to pituitary gland

Question 7

What is Sheehan’s syndrome?

Answer 7

Massive blood loss during childbirth leading to pituitary necrosis

Question 8

What is tertiary adrenal insufficiency?

Answer 8

Result of inadequate CRH release by hypothalamus

Question 9

What is tertiary adrenal insufficiency caused by?

Answer 9

Being on long term oral steroids (more than 3 weeks) causing suppression of hypothalamus

Question 10

Presentation of adrenal insufficiency?

Answer 10

• Fatigue
• Nausea
• Abdominal pain
• Cramps

Question 11

Signs of adrenal insufficiency?

Answer 11

Hypotension

Bronze hyperpigmentation of skin

Question 12

Investigations for adrenal insufficiency?

Answer 12

• Short synacthen test (ACTH stimulation test)
• Hyponatraemia
• Hyperkalaemia
• Early morning cortisol
• ACTH levels
• Adrenal autoantibodies
• CT or MRI adrenal glands
• MRI pituitary

Question 13

What is sometimes the only presenting feature of adrenal insufficiency?

Answer 13

Hyponatraemia

Question 14

Gold standard test for adrenal insufficiency?

Answer 14

Short synacthen test

Question 15

What will ACTH levels be like in primary adrenal failure?

Answer 15

ACTH level is high

-Pituitary is trying very hard to stimulate adrenal glands without -ve feedback in absence of cortisol

Question 16

What will ACTH levels be like in secondary adrenal failure?

Answer 16

ACTH level is low

-Adrenal glands not producing cortisol because they are not being stimulated by ACTH

Question 17

How short synacthen test (ACTH stimulation test) is done?

Answer 17

Performed in morning, give synacthen (synthetic ACTH).

Blood cortisol is measured at baseline, 30mins and 60 mins post- administration

Question 18

Result of short synacthen test for a person with healthy adrenal glands?

Answer 18

Will produce cortisol & the level should double at least

Question 19

What does it mean if cortisol levels don’t double in a synacthen test?

Answer 19

Failure for cortisol to rise = primary adrenal insufficiency

Question 20

Treatment of adrenal insufficiency?

Answer 20

Replacement steroids titrated to clinical signs and electrolytes

Question 21

What is hydrocortisone?

Answer 21

Glucocorticoid hormone & used to replace cortisol

Question 22

What is fludrocortisone?

Answer 22

Mineralocorticoid hormone & is used to replace aldosterone

Question 23

What do you do to doses of steroid in acute illness?

Answer 23

DOUBLED

Question 24

What is Addisonian crisis?

Answer 24

Describes acute presentation of severe Addison’s = life threatening due to lack of steroid hormones

Question 25

Presentation of Addisonian crisis?

Answer 25

• Reduced consciousness
• Hypotension
• Hypoglycaemia
• Hyponatraemia, hyperkalaemia
• Patients can be very unwell

Question 26

Management of Addisonian crises?

Answer 26

-Intensive monitoring
-Parenteral roids (IV hydrocortisone 100mg start then 100mg every 6 hours)
-IV fluid resus
Monitor electrolytes and fluids