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Endocrine 2 > Adrenal insufficiency > Flashcards

Adrenal insufficiency Flashcards

1
Q

What is Primary vs Secondary Adrenal insufficiency?

A

Primary: Adrenal Gland insufficiency (ALL THREE)

Secondary: Damage to Hypothalamus or Pituitary
Deficiency in CRH
Deficiency in ACTH
CORTICOSTEROIDS ONLY

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2
Q

What is produced in each part of the Adrenal Gland?

A

Glomerulosa: Aldosterone
Fasiculata: Cortisol
Reticularis: Androgens

Medulla: NE and Epi

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3
Q

What is seen if there is Adrenal Medulla insufficiency?

A

Not seen. Paragangliomas along the spinal cord also produce NE and Epi.

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4
Q

What is seen in Adrenal Medulla excess?

A

Pheochromocytoma caused by a tumor of the adrenal Medulla.

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5
Q

What are the androgens made in the Arenal Cortex?

A

DHEA

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6
Q

What is the effect of DHEA

A

Secondary Sex Charicteristics pubic and axillary hair

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7
Q

What system regulates blood pressure via the kidneys?

A

Renin-Angiotensin-Aldosterone Axis

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8
Q

What is the common precursor molecule of all the Adrenal hormones?

A

POMC

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9
Q

What are the most common causes of Primary Adrenal Insufficiency?

A 
Autoimmune dificiency (developed Countries)
TB (non-developed countries)
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10
Q

What are the lab findings in Primary Adrenal Insufficiency?

A

Dec Cortisol, Inc ACTH
Dec Aldosterone, Inc Renin
Dec DHEA

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11
Q

What are the clinical findings in Primary Adrenal Insufficiency?

A

Hyperpigmantation

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12
Q

What are the Cortisol levels that are indicative of Primary AI?

A
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13
Q

What is the Tx of PRimary Adrenal Insuff.?

A 
Cortisol 12-15mg/day
Aldosterone: 0.1 mg/day
Meds:
Hydrocortisone 15-20mg or 5-10mg(2xday)
Prednisone 2.5-7.5mg 1x
Fludrocortisone .05-.2mg 1x
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14
Q

What are the guidelines for dose adjustment for Steroids?

A

Minor stress: fever, vomiting, diarrhea => Double Dose
Major Stress: CABG/Abdominal Surg/Trauma
Stress dose! 200-300mg/day then taper down

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15
Q

What is the Tx of an adrenal Crisis?

A 
Salt: 0.9% normal saline
Sugar: 5% dextrose
Steroids: hydrocortisone 100mg IV
Support
Search: precipitating illness
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16
Q

How is Stress Dose tapering done?

A

Stress dose 300mg/day
Pharma dose until stable (60mg/day)
Taper to Physio Dose: 30mg/day

17
Q

What is the main cause of Secondary Adrenal insufficiency?

A

Transient: Exogenous use of Steroids
ABRUPT CESSATION OF EXOGENOUS GLUCOCORTICOIDS
Permanent: Panhypopituitarism

18
Q

What is seen in secondary AI?

A

LOW CORTISOL

LOW ACTH

19
Q

How is Metyrapone and Hypoglycemia used to test for 2ndry AI?

A

Metyrapone: Blocks conversion of 11-deoxycortisol to Cortisol
Compensatory inc in ACTH

Hypoglycemia is a stress that will cause ACTH secretion

20
Q

What is the Tx of Secondary AI?

A

Same except no mineralocorticoids

Endocrine 2 (16 decks)

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