Adrenal insufficiency Flashcards
What do glucocorticoids primarily regulate?
Carbohydrate, protein, and fat metabolism, stress response, inflammation.
What do mineralocorticoids primarily regulate?
Electrolyte and fluid balance (mainly sodium and potassium).
What is adrenal insufficiency?
Inadequate production of adrenal hormones — Cortisol, aldosterone, adrenal androgens.
What are the two main types of adrenal insufficiency?
Primary (Addison’s) — adrenal gland destruction
Secondary — inadequate ACTH (e.g. from pituitary suppression)
Common cause of secondary insufficiency?
Long-term corticosteroid use suppressing the HPA axis.
Hormones deficient in Addison’s disease?
Cortisol, aldosterone, adrenal androgens.
What symptoms suggest Addison’s disease?
Fatigue, hyperpigmentation, salt craving, GI symptoms, postural hypotension.
What can precipitate an Addisonian crisis?
Illness, stress, surgery, dehydration, steroid withdrawal.
Symptoms of adrenal crisis?
Shock, hypotension, vomiting, abdominal pain, low GCS, hypoglycaemia.
What is the emergency treatment?
100 mg IM/IV hydrocortisone stat dose
IV fluids (0.9% saline)
Treat underlying cause (e.g., infection)
Then continue hydrocortisone infusion over 24 hrs.
First test if adrenal insufficiency is suspected in adults?
9 am serum cortisol.
What cortisol level suggests adrenal insufficiency?
<100 nmol/L → likely → urgent admission
100–500 nmol/L → refer to endocrinology
What is first-line glucocorticoid replacement?
Hydrocortisone, 15–25 mg/day in divided doses.
What is used for mineralocorticoid replacement?
Fludrocortisone, 50–200 mcg/day.
What should patients carry for emergencies?
Steroid card, MedicAlert, and hydrocortisone injection kit.
What must not be done with long-term steroids?
Sudden withdrawal — taper slowly.
What to do before minor procedures (e.g. dental work)?
Take extra oral glucocorticoid dose before and after.
What are glucocorticoid effects?
Anti-inflammatory, immunosuppressive, metabolic effects.
What are mineralocorticoid effects?
Sodium retention, potassium excretion → fluid retention.
Which steroids are preferred in long-term disease suppression?
Prednisolone, dexamethasone, betamethasone (low mineralocorticoid activity)
Why is hydrocortisone not ideal for long-term suppression?
High mineralocorticoid effect → fluid retention.
Why are some corticosteroids better for topical use?
They have strong local effects and minimal systemic absorption.
