adrenal insufficiency

Question 1

Define adrenal insufficiency

Answer 1

Insufficient production of steroid hormones such as cortisol and aldosterone by the adrenal glands

Question 2

what are the three main types of pathophysiology behind adrenal insufficiency?

Answer 2

1. Primary adrenal insufficiency
2. Secondary Adrenal insufficiency
3. Tertiary Adrenal insufficiency

Question 3

describe primary adrenal insufficiency

Answer 3

-Damage of the adrenal glands results in reduced steroid secretion.
-Usually due to autoimmune destruction
( Addisons disease)

Question 4

describe secondary adrenal insufficiency

Answer 4

-Pituitary gland dysfunction leads to low ACTH release which means low cortisol release.
-Usually due to pituitary adenomas, surgery, trauma, radiotherapy or Sheehan’s syndrome.

Question 5

describe tertiary adrenal insufficiency

Answer 5

-Hypothalamus dysfunction leads to decreased CRH release leading to low ACTH and low cortisol.
-Usually, a result of oral steroid use which causes a negative feedback loop resulting in low CRH.

Question 6

what are the risk factors for adrenal insufficiency?

Answer 6

-Female
-Adrenocortical Antibodies
-Other autoimmune diseases
-Age
-Genetics

Question 7

what is the epidemiology for adrenal insufficiency?

Answer 7

-Developed Countries – Usually autoimmune-related causes

-Developing Countries – Tuberculosis and Sarcoidosis as causes

Question 8

what are the causes for adrenal insufficiency?

Answer 8

-Autoimmune
-Infections
-Oral Steroid Use
-Medications
-Adrenal/Pituitary/Hypothalamus Dysfunction
-Adrenal Haemorrhage and Infarction

Question 9

what are the signs for adrenal insufficiency?

Answer 9

-Bronze Hyperpigmented skin**
-Postural Hypotension
-Hypoglycaemia
-Menstrual irregularities
-Change in Body Hair distribution

Question 10

what are the symptoms for adrenal insufficiency?

Answer 10

-Weight loss
-Nausea and vomiting
-Fatigue
-Dizziness
-Salt craving
-Weakness

Question 11

what are key findings when diagnosing adrenal insufficiency?

Answer 11

Hyponatraemia is a key finding.
So are hyperkalaemia and hypoglycaemia

Question 12

what is the gold standard test done to diagnose adrenal insufficiency?

Answer 12

-Short SynACTHen Test is the gold standard as it measures the adrenal gland’s response to ACTH.
-Normally cortisol would double, failure to do so indicates adrenal insufficiency.

Question 13

what other things can you measure to diagnose adrenal insufficiency?

Answer 13

-You can measure ACTH directly.
-9 a.m. cortisol test measures cortisol levels.
-MRI Imaging of adrenal and pituitary glands.

Question 14

what type of adrenal insufficiency does high ACTH indicate?

Answer 14

primary

Question 15

what type of adrenal insufficiency does low ACTH indicate?

Answer 15

secondary

Question 16

what is the regular treatment for adrenal insufficiency?

Answer 16

-Hydrocortisone to replace cortisol
-Fludrocortisone to replace Aldosterone.
-Double this dose during illnesses and infections.

Question 17

what is an Addisonian crisis and what does it present with?

Answer 17

-This is a severe lack of steroids and is life threatening.
-Can present with reduced consciousness, hypotension, hypoglycaemia as well as classic hyponatraemia and hyperkalaemia

Question 18

what is the treatment for addisonian crisis?**

Answer 18

-ABCDE
-IM or IV Hydrocortisone (100mg)
-IV Fluids
-IV dextrose to fix hypoglycaemia
-Monitor Electrolytes