Adrenal Insufficiency

Question 1

what is adrenal insufficiency

Answer 1

insufficient hormone production from adrenal glands esp. glucocorticoids (cortisol) and mineralocorticoids (aldosterone)…also adrenal androgens

Question 2

describe primary adrenal insufficiency

Answer 2

• Addisons Disease
• inability of adrenal glands to produce hormones
• due to destruction of both adrenal cortices
• usually autoimmune

Question 3

why does primary adrenal insufficiency usually not occur if only one adrenal cortex is destroyed

Answer 3

if only one is destroyed, other can take over

Question 4

describe secondary adrenal insufficiency

Answer 4

• hypothalamic/pituitary abnormality

- results in insufficient ACTH

Question 5

what is the most common cause of 1° AI in developed world

Answer 5

autoimmune

Question 6

what is the most common cause of 1° AI in developing world

Answer 6

TB

Question 7

what is the most common cause of 2° AI

Answer 7

steroid use

Question 8

describe what is seen in Px due to lack of glucocorticoids

Answer 8

• hypoglycaemia
• ↓fat and prot metabolism
• weight loss (reduced appetite)
• fatigue/poor exercise tolerance
• poor stress tolerance –> death

Question 9

describe what is seen in Px due to lack of mineralocorticoids

Answer 9

• hyponatraemia
• hyperkalaemia
• ↑H+
• hypovolaemia due to loss of H2O in urine –> hypotension
• ↓CO –> circulatory collapse –> shock –> death

Question 10

describe what is seen in Px due to lack of adrenal androgens

Answer 10

males = no effect (testosterone) 
females = mood changes

↓libido

Question 11

what investigations can be done in suspected adrenal insufficiency

Answer 11

• can do Synacthen test (ACTH stim)
• in 1° = ↓cortisol, ↑ACTH
• in 2° = ↓cortisol, ↓ACTH
• key bloods = U&E –> ↑K+, ↓Na+

Question 12

outline the management for adrenal insufficiency

Answer 12

hormone replacement: give corticosteroids

• glucocorticoid –> hydrocortisone
• mineralocorticoid –> fludrocortisone

surgery:
- surgical removal of tumour if indicated