Adrenal Insufficiency Flashcards
Other causes of primary renal insufficiency?
- Chronic granulomatous infections (histoplasmosis, Coccidioides)
- Adrenal hemorrhage
- Adrenal metastasis (lung, breast, Stomach cancer)
- X-linked adrenoleukodystrophy
symptoms and labs of adrenal insufficiency? Most common cause? Next step?
Sx: Orthostatic hypotension, abdominal pain, constitutional symptoms
Labs: Hyponatremia, hyperkalemia, acidosis, hypoglycemia
Idiopathic autoimmune destruction
Draw cortisol level, give saline with glucose and stress doses of corticosteroids
Patients with AIDS develop adrenal involvement as a result of these infections?
CMV, MAI
In primary renal insufficiency, patient deficient in?
Cortisol and aldosterone
secondary adrenal insufficiency? Most common cause?
Lack of ACTH. Exogenous corticosteroids
Symptoms of acute renal insufficiency?
Weakness, nausea/vomiting, fever, hypotension, tachycardia
Laboratory findings in acute adrenal sufficiency?
Hyponatremia, hypoglycemia,
hyperkalemia, metabolic acidosis,
eosinophilia, azotemia
Septic shock versus acute adrenal insufficiency?
Hyperglycemia versus hypoglycemia
Effect of pressers on acute adrenal insufficiency? Best tx?
Refractory to pressors. Will reverse which steroids
Difference in signs of primary versus secondary adrenal insufficiency?
Secondary: no hyperkalemia or volume depletion (RAAS still makes ALDO) or hyperpigmentation (no ACTH)
Diagnosing Adrenal insufficiency?
- Morning plasma cortisol level <5
2. 7+ increase in cortisol level (Or max level of 18 ug) after 250 ug ACTH
Gold standard for testing entire HPA axis?
Insulin-glucose tolerance test
Treatment of acute renal insufficiency?
D5, with NS and steroids (hydrocortisone 100 mg every six – eight hours)
Why use hydrocortisone?
Provides both glucocorticoid and mineralocorticoid activity
Long-term treatment for patients with primary adrenal insufficiency?
Hydrocortisone 25 to 30 mg
Fludrocortisone .1-.2 mg
