Adrenal Insufficiency (3) Flashcards
What is this?
What is the primary type known as?
→ What are its causes?
What occurs in the secondary type?
→ What are its causes?
What occurs in the tertiary type?
→ What causes it?
➊ Destruction of adrenal cortex leading to reduction of hormone production
➋ Addison’s Disease
→ • Autoimmune - leading to cortisol and aldosterone deficiency
• Surgical removal
• Trauma
• Infections esp. TB
• Waterhouse-friderichsen syndrome
➌ Loss of pituitary function, leading to inadequate ACTH and cortisol deficiency
→ • Iatrogenic
• Surgery
• Infection
• Sheehan’s syndrome (massive blood loss during childbirth leads to ishcaemia and necrosis of the pituitary gland)
➍ Loss of hypothalamic function, leading to Inadequate CRH and
cortisol deficiency
→ Long-term Steroid use (3+ wks)
How does it present?
• Hypotension
• Fatigue and weakness
• Skin hyperpigmentation - ACTH stimulates production of melanin
• Abdominal pain, nausea, weight loss
What are the main investigations to do?
→ What will be seen?
What is needed to confirm the diagnosis?
→ What result is expected?
How is it managed?
➊ • Sodium - low
• Potassium - high
• Cortisol - low
• Aldosterone - low in primary, normal in secondary
• ACTH - high in primary, low in secondary
• CT adrenals or MRI head
➋ Short Synacthen test
→ No rise in cortisol in primary, rise in secondary
➌ • Hydrocortisone (cortisol replacement)
• Fludrocortisone (aldosterone replacement)
Addisonian Crisis:
What is it?
What can it be triggered by?
How is it managed?
➊ Severe addison’s with life-threatening presentation - Reduced consciousness, Hypotension, Hypoglycaemia, Hyponatraemia, Hyperkalaemia
➋ • Infection
• Trauma
• Sudden stopping of long-term steroids
➌ • Aggressive fluid resuscitation and IV steroids
• Glucose if hypoglycaemic
