Adrenal insufficiency Flashcards
Addisons aka?
Primary adrenal insufficiency
Pathology of addisons?
Destruction of adrenal cortex → glucocorticoid and mineralocorticoid deficiency
Causes of Addisons?
- Autoimmune destruction: 80% in the UK
- TB: commonest worldwide
- Metastasis: esp from lung
General symptoms of addisons?
- Wt. loss + anorexia,
- Lethargy, depression
- hypoglycaemia
GI symptoms of addisons?
GI: n/v, abdo pain, diarrhoea/constipation
Skin symptoms of addisons?
Skin:
- Hyperpigmentation: buccal mucosa, palmer creases,
- Vitiligo
CVS symptoms of addisons?
CVS: Postural hypotension → dizziness, faints
Blood results for addisons
Low cortisol
U+E: ↓Na + ↑K
↓glucose
FBC: Anaemia
How to differentiate between a problem with pituitary or adrenal gland when los cortisol levels?
EITHER Short synACTHen test:
- measure cortisol before and after tetracosactide (synthetic ACTH)
- Exclude Addison’s if ↑ cortisol
OR ↑ 9am ACTH (usually low)
Addisons medical treatment ?
Replace
- Hydrocortisone
- Fludrocortisone
Addison cortisol level control advices?
Advice:
- Don’t stop steroids suddenly
- ↑ steroids during intercurrent illness, injury
Why follow up addisons pts?
- Watch for autoimmune disease
- T1DM, Coeliac, thyroid
Secondary adrenal insufficiency?
i.e. hypothalamo or pituitary failure
Causes of Secondary adrenal insufficiency
- Chronic steroid use → suppression of HPA axis
- Pituitary microadenoma
Features of Secondary adrenal insufficiency
- Normal mineralocorticoid production
- No pigmentation (ACTH ↓)
