Adrenal insufficiency Flashcards
what part of the adrenal gland is affected in adrenal insufficiency
adrenal CORTEX does not produce adequate steroid hormones
what hormones are not produced
cortisol, aldosterone, sex hormones
NB conn’s and cushing’s are basically the opposite to adrenal insufficiency
what is addison’s disease
chronic primary adrenal insufficiency
what causes addison’s disease
autoimmune adrenalitis
TB
what causes secondary insufficiency
- pituitary tumour
- long term steroids (leads to suppression of ACTH secretion
which hormones is not affected in SECONDARY insufficiency
aldosterone
examination finding specific to addison’s
brown/grey skin (due to compensatory ACTH)
sx (nb often diagnosed late)
anorexia, dizzy, myalgia, nv, abdo pain, diarrhoea/constipation, postural hypotension
acute presentation?
adrenal crisis (shock due to low cortisol, often precipitated by trauma or infection) pulse increased, vasoconstriction, postural hypotension, oliguria, confusion
dx
low cortisol + high acth (addison’s or low acth (secondary) + clinical picture
ix
short acth stimulation test (short synacthen test). given acth and cortsol levels then measured. addison’s cortisol does not rise. secondary disease, cortisol rises
do blood findings
hypglycaemia (due to low cortisol)
hyponatraemia (in addison’s due to low aldosterone)
emergency rx of adrenal crisis
SHAG saline hydrocort abx (if infection) glucose (if hypoglyc)
what to do with hyperkalaemia
calcium gluconate
rx addison’s
hydrocort/pred to replace cort
fludrocort (to replace aldosterone)
