Adrenal insufficiency

Question 1

What is adrenal insufficiency

Answer 1

Inability to produce glucocorticoids

Question 1

What does no inrease in cortisol in a short synacthen test signla

Answer 1

Primary adrenal insufficiency

Question 2

What is primary adrenal insufficiency

Answer 2

Non functioning gland
Increased CRH + ACTH
No glucorticoids

Question 3

Secondary adrenal insufficiency what is it

Answer 3

Increased CRH
Low ACTH and glucocorticoids

Question 4

Tertiary adrenal insufficiency

Answer 4

Low CRH, ACTH and glucocorticoids

Question 5

What does the cortex vs medulla of the adrenal gland produce

Answer 5

Cortex - mineral, clucocorticoids and androgens
Medulla - catecholamines

Question 6

HPA axis

Answer 6

Negative feedback glucocorticoids on hypothalamus + anterior pituitary
Hypothalamus -> CRH -> Anterior piuitary -> ACTH -> Adrenal cortex -. corticoids

Question 7

Considerations as part of hormone testing

Answer 7

Age
Gender
Pubertal status
BMI
timing - hour, cycle
Medicaitons

Question 8

What is normal range for hormones

Answer 8

Have to consider normal variety in popultion - +/1 2SDs

Question 9

Hpw does glucose spike in body

Answer 9

Bimodal distribution - second peak two hours after first

Question 10

When suspicious of insulin levels

Answer 10

If high glucose and normal insulin - should respond rapidly to glucose

Question 11

What PTH level is abnormal with a high calcium

Answer 11

Normal - as Ca increases PTH should be supressed rapidly

Question 12

What can low glucose and normal inuslin cause

Answer 12

Hypos, insulinoma

Question 13

What can long term steroid use cause

Answer 13

Decreased ACTH supresson -> secondary adrenal insufficiency

Question 14

What tests results would suggest secondary adrenal insufficiency

Answer 14

• Baseline cortisol: 106 nmol/L (119-618) LOW
• Cortisol at 30 minutes:240 nmol/L (119-618) normal
• Cortisol at 60 minutes: 470 nmol/L (119-618)normal