Adrenal Insufficiency

Question 1

What happens in adrenal insufficiency

Answer 1

The adrenal glands do not produce enough steroid hormones, particularly cortisol and aldosterone

Question 2

What is Addison’s disease (primary adrenal insufficiency)

Answer 2

Refers to a specific condition where the adrenal glands have been damaged resulting in reduced cortisol and aldosterone secretion.

Question 3

What is secondary adrenal insufficiency

Answer 3

Inadequate secretion of ACTH from the anterior pituitary

Question 4

What is tertiary adrenal insufficiency

Answer 4

Inadequate CRH release by the hypothalamus

Question 5

Cause of primary adrenal insufficiency

Answer 5

Autoimmune

Question 6

Causes of secondary adrenal insufficiency

Answer 6

Loss or damage to the pituitary such as congenital underdevelopment, surgery, infection, loss of blood flow or radiotherapy

Question 7

Causes of tertiary adrenal insufficiency

Answer 7

Result of patients on long term oral steroids causing hypothalamus suppression

Question 8

Features of adrenal insufficiency in babies

Answer 8

Lethargy, vomiting, poor feeding, hypoglycaemia, jaundice, failure to thrive

Question 9

Features of adrenal insufficiency in older children

Answer 9

Nausea and vomiting, poor weight gain, weight loss, reduced appetite, abdominal pain, muscle weakness or cramps, developmental delay, poor academic performance, bronze hyperpigmentation

Question 10

Primary adrenal failure investigation results

Answer 10

Low cortisol.
High ACTH.
Low aldosterone.
High renin.

Question 11

Secondary adrenal failure investigation results

Answer 11

Low cortisol.
Low ACTH.
Normal aldosterone.
Normal renin.

Question 12

What is the short synacthen test used for

Answer 12

Used to confirm adrenal insufficiency, synthetic ACTH is given and cortisol is measured at baseline, 30 mins, and 60 mins after administration, cortisol normally should rise to double the baseline

Question 13

Management of adrenal insufficiency

Answer 13

Replacement of steroids titrated to signs, symptoms and electrolytes. Hydrpcortisone and fludrocortisone are used.

Question 14

Sick day rules for adrenal insufficiency patients

Answer 14

Dose of steroid increased, blood sugar monitored closely, and IM injection if vomiting or diarrhoea

Question 15

What happens in an addisonian/adrenal crisis

Answer 15

Acute presentation of severe addisons where absence of steroids causes a life threatening situation. Present with reduced consciousness, hypotension, hypoglycaemia, hyponatraemia and hyperkalaemia.