Adrenal Insufficiency

Question 1

What is another name for adrenal insufficiency.

Answer 1

Addison’s disease.

Question 2

What are some causes of adrenal insufficiency. (3)

Answer 2

Exogenous steroids for long enough that the pituitary-adrenal-axis becomes suppressed.
Anyone with overwhelming sepsis.
Metastatic cancer.

Question 3

What are the consequences of arenal insufficiency.

Answer 3

Adrenal insufficiency can lead to deadly hypovolaemic shock.

Question 4

What is primary adrenal insufficiency.

Answer 4

Addison’s disease.

Question 5

How common is primary adrenal insufficiency. (2)

Answer 5

Rare.

0.8/100,000.

Question 6

What occurs in primary adrenal insufficiency.

Answer 6

Destruction of the adrenal cortex.

Question 7

What is deficiency in adrenal insufficiency. (2)

Answer 7

Glucocorticoid (cortisol) and mineralocorticoid (aldosterone) deficiency.

Question 8

What are the signs and symptoms of primary adrenal insufficiency.

Answer 8

Vague and capricious.

Very easy to misdiagnose and commonly done.

Question 9

What are the causes of primary adrenal insufficiency. (7)

Answer 9

80% are due to autoimmunity in the UK.
TB (commonest worldwide). 
Adrenal metastases. 
Lymphoma. 
Opportunistic infections in HIV. 
Adrenal haemorrhage. 
Congenital.

Question 10

What are the symptoms of adrenal insufficiency. (22)

Answer 10

Often diagnosed late:
Lean.
Tanned. 
Tired.
Tearful.
Weakness. 
Anorexia. 
Dizzy. 
Faints. 
Flu-like myalgias/arthralgias.
Depression. 
Psychosis. 
Low self esteem. 
Nausea/vomiting. 
Abdominal pain. 
Diarrhoea/constipation. 
Pigmented palmar creases and buccal mucosa. 
Postural hypotension. 
Vitiligo. 

May be signs of critical deterioration:
Shock.
Fever.
Coma.

Question 11

What patient should you always consider Addison’s in.

Answer 11

Add patients with unexplained abdominal pain or vomiting.

Question 12

What is seen on the blood test of a patient with Addison’s disease. (7)

Answer 12

Low sodium. 
High potassium. 
Low glucose. 
Uraemia. 
High calcium. 
Eosinophilia. 
Anaemia.

Question 13

How do you diagnose primary adrenal insufficiency.

Answer 13

Short ACTH stimulation test (Synacthen).

Question 14

What is the commonest cause of secondary adrenal insufficiency.

Answer 14

Iatrogenic, due to long term steroid therapy leading to suppression of the pituitary-adrenal axis.

Question 15

When does secondary adrenal insufficiency become apparent.

Answer 15

When you withdraw the steroids.

Question 16

What are some rare causes of secondary adrenal insufficiency. .

Answer 16

Hypothalamic pituitary disease leading to decreased ACTH production (mineralocorticoid production remains intact, and there is no hyperpigmentation as in los ACTH).