Adrenal Insufficiency Flashcards
most common cause of primary adrenal insufficiency?
autoimmune
secondary adrenal insufficiency is due to?
tumours (pituitary adenoma), surgery, radiotherapy, sheehans trauma
tertiary adrenal insufficiency is due to?
inadequate CRH from hypothalamus, due to long term oral steroids ( more than 3 weeks)
symptoms of adrenal insufficiency?
Fatigue
Muscle weakness
Muscle cramps
Dizziness and fainting
Thirst and craving salt
Weight loss
Abdominal pain
Depression
Reduced libido
signs of adrenal insufficiency?
Bronze hyperpigmentation of the skin, particularly in creases (ACTH stimulates melanocytes to produce melanin)- creases, scars, lips and buccal mucosa
Hypotension (particularly postural hypotension – with a drop of more than 20 mmHg on standing)
investigation findings?
HYPONATRAEMIA
hyperkalaemia
hypoglycaemia
raised creatinine and urea
hypercalcaemia
test of choice for diagnosing adrenal insufficiency?
short synacthen test
ACTH levels in adrenal insufficiency?
high in primary adrenal insufficiency, low in secondary
which autoantibodies are present in autoimmune adrenal insufficiency?
adrenal cortex antibodies
21 hydroxylase antibodies
short synacthen test?
acth stimulation, blood cortisol should double otherwise indicated addisons, secondary adrenal insufficiency
long synacthen test is used to check?
difference in primary and secondary, high in primary and low in secondary
management of adrenal insufficiency?
hydrocortisone 20-30mg per day, fludrocortisone , id tag steroid card
what happens in acute illness in those who are steroid dependent?
double dose of hydrocortisone
causes of hypoadrenalism?
TB, metastases, meningococcal septicaemia, HIV, antiphospholipid syndrome,
pituitary disorders
exogenous glucocorticoid therapy
wjat is electrolyte abnormality in addisons?
metabolic acidosis
