Adrenal Insufficiency Flashcards
What is adrenal insufficiency?
When there is not enough cortisol or aldosterone
What is another term for primary adrenal insufficiency?
Addison’s Disease
What is Addison’s Disease?
Autoimmune damage to the adrenal glands resulting in reduced cortisol and aldosterone production
What is secondary adrenal insufficiency?
Inadequate ACTH stimulating the adrenal glands leading to low cortisol release
What is secondary adrenal insufficiency?
Where there is inadequate ACTH to stimulate the adrenal glands, resulting in low cortisol release
What causes secondary adrenal insufficiency?
Loss/damage to the adrenal glands caused by tumour, infarction, radiotherapy, Sheehan’s syndrome (lack of blood supply to pituitary following PPH)
What is tertiary adrenal insufficiency?
Where there is inadequate corticotropic-releasing hormone (CRH) produced by the hypothalamus.
What is the cause of tertiary adrenal insufficiency?
Long-term steroid use
How does long-term steroid use suppress CRH production by the hypothalamus?
Negative feedback on the hypothalamus suppresses CRH production
How can tertiary adrenal insufficiency be avoided?
Tapering long-term steroids
What are the symptoms of adrenal insufficiency?
Fatigue
Nausea
Abdominal pain
Reduced libido
Cramps
What are the signs of adrenal insufficiency?
Bronze hyperpigmentation - look at skin creases!
Hypotension - part. postural hypotension
How does adrenal insufficiency lead to bronze hyperpigmentation?
ACTH stimulates melanocytes to produce melanin
What test is used in suspected adrenal insufficiency?
Short and long synacthen tests
What is the short synacthen test?
- Give synacthen (synthetic ACTH)
- Measure blood cortisol at baseline, 30 mins and 60 mins
- Failure to rise more than double baseline indicates Addison’s Disease
