Adrenal insufficiency Flashcards
what is adrenal insufficiency?
When the adrenal gland doesn’t produce either enough cortisol or aldosterone.
what is Addisons disease?
A specific condition where theres autoimmune destruction of the adrenal glands.
Most common cause of primary hypoadrenalism in the UK.
what is primary adrenal insufficiency?
Most commonly Addisons disease.
Where theres not enough cortisol or aldosterone due to a problem with the adrenal gland itself.
What is secondary adrenal insufficiency?
When theres not enough ACTH being produced from the pituitary hormone - causing a reduction in adrenal stimulation and function.
what is Sheehans syndrome?
when theres massive blood loss during child birth, leading to pituitary gland necrosis.
This results in low ACTH and adrenal insufficiency in turn.
What is the most common cause of tertiary adrenal insufficiency?
Its when the hypothalamus doesn’t produce enough cortisol releasing hormone.
Most common cause is long term oral steroids for >3 weeks.
What should be done after long term steroid us?
Steroids should be tapered down to allow the hypothalamus time to start producing hormones again.
what are the symptoms of adrenal insufficiency?
Fatigue nausea cramps abdominal pains reduced libido hyperpigmentation of skin hypotension (postural) hyponatraemia vitiligo
What is often the only sign seen in adrenal insufficiency?
Hyponatraemia
why is hyperpigmentation common?
ONLY IN PRIMARY adrenal insufficiency.
due to no negative feedback from the adrenal gland, the anterior pituitary produces more ACTH.
ACTH can also stimulate the melanocytes in the skin to produce more melanin - causing pigmentation.
What are the investigations for adrenal insufficiency?
Sodium levels (LOW) Potassium levels (HIGH) short synacthen test **** Adrenal autoantibodies CT MRI
what is the short synacthen test?
its performed in the morning.
Synacthen is given (synthetic ACTH) and blood cortisol levels are measured at the start, after 30 mins and after 60 mins.
NORMALLY - the cortisol levels should rise over double.
what indicates primary adrenal insufficiency in the short synacthen test?
failure of the cortisol to rise as a result of the synthetic ACTH.
what is the treatment for adrenal insufficiency?
Cortisol - Hydrocortisone
Aldosterone - fludrocortisone
**Steroid dependent for life.
What should be done on sick days?
Steroid doses should be DOUBLED in acute illness (to match the bodies natural increase in hormones).
