Adrenal insufficiency Flashcards

1
Q

What is primary adrenal insufficiency?

A

Destruction of the Adrenal leading to lack of Cortisol, Aldosterone, DHEAS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Signs and symptoms of primary adrenal insufficiency as correlated to the hormone lacking

A

Decreased Cortisol: Hypoglycemia, Confusion, Weakness, Fatigue. Decreased Aldosterone: Hyponatremia & Hyperkalemia, Dehydration, Hypotension, Salt craving, Weakness, Abdominal pain, nausea, decreased appetite. Decreased DHEAS: Fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

General symptoms (repetitive) of adrenal insufficiency

A

Salt cravings “I love to drink the juice around the pickles”, Fatigue, Muscle weaknesss, Dizzyness, Nausea, Vomiting, Abdominal pain, “Sense of impending doom, feeling down”, Weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

General signs of symptoms of adrenal insufficiency

A

Postural drop in blood pressure, Postural increase in pulse, Weight loss, Abdominal tenderness, Muscle weakness, Hyperpigmentation of gum lines, palmar creases, and scars (Primary AI); Vitiligo (Primary AI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Causes of primary adrenal insufficiency

A

Autoimmune: Poly Glandular Autoimmune I and II. Infections: TB, histoplasmosis, coccidiomycosis, cryptococcus, HIV, CMV, MAI, toxoplasma, Syphilis Metastatic Disease (lung, breast, stomach and colon cancer, lymphoma). Adrenal Hemorrhage (Waterhouse-Friderichsen Syndrome, Lupus anticoagulant, Anticoagulation). Drugs (interfere with cortisol synth): Metyrapone, Aminoglutethimide, Ketoconazole, Rifampin, Barbiturates, Phenytoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Familial causes of adrenal insufficiency - most common in peds

A

Congenital Adrenal Hyperplasia, Adrenoleukodystrophy, Adrenomyeloneuropathy, Familial glucocorticoid deficiency, Familial glucocorticoid resistance, Defective cholesterol metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

APS Type 1

A

Single gene disorder. Aire is a TF in thymus, defect causes failure to delete auto reactive T cells - leads to autoimmunity. Associated with Hypoparathryoidism, Chronic Mucocutaneous Candidiasis (oral thrush), Adrenal Insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

APS Type 2

A

More common, linked to HLA region of chromo 6. Associated with diabetes, addison’s (100%) and thyroid autoimmunity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Secondary adrenal insufficiency?

A

Same thing really. Caused by Prior history of steroid use - can be irreversible (need to taper off) - hypo and pituitary are impaired. Also caused by Pituitary Disease / Hypothalamic Disease, Isolated ACTH Deficiency, post transphenoidal pituitary surgery, Peripheral Resistance to glucocorticoids. Secondary is more common that primary insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do we test for adrenal insufficiency?

A

Best is ACTH stimulation. baseline cortisol, ACTH - ACTH 250 ug IV push - cortisol at 1 hr, should double from its baseline in 1 hour and should be at least 550 nmol/L.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Primary vs secondary adrenal insufficiency

A

1 is low ACTH and low cortisol, low Na, high K, low glucose, hyperpigmentation. 2 is high ACTH and low cortisol, low Na (due to low cortisol, although aldosterone still there), normal K (aldosterone is stimulated by renin pathway), low glucose.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Adrenal crisis - what is it?

A

Weight Loss, Fatigue, Weakness, Severe Hypotension, Abdominal Symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Tx for adrenal crisis

A

IV fluids, IV steroids, treat whatever precipitated it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Long term management of addison’s

A

Medic alert bracelet. Glucocorticoids (prednisone, hydrocortisone, cortisone Acetate, Dexamethasone), Mineralocorticoids – Florinef (for 1 insufficiency). Pt needs to double the glucocorticoids during minor illness or stress (to make it like a normal response), IV steroids for major illness/surgery/hospitalization.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Complications of using glucocorticoids

A

Adrenal Suppression, Avascular Necrosis of the Hip, Cushing’s Syndrome, Diabetes, Hypertension, Obesity, Hypertriglyceridemia, Osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly