Adrenal insufficiency

Question 1

What is adrenal insufficiency?

Answer 1

when the adrenals do not produce/release enough aldosterone or cortisol

Question 2

What are the causes of addisons disease?

Answer 2

Developed world = autoimmune disease
Developing = TB
Sepsis and bleeding into the gland

Question 3

What are the 4 main functions of cortisol?

Answer 3

Help to regulate BP, immune system
Help to balance insulin regulatory effects on blood glucose level
Help to control bodies response to stress

Question 4

What is the function of aldosterone?

Answer 4

Helps to regulate salt levels in blood and control BP

Question 5

Which part of the adrenals produce aldosterone and cortisol?

Answer 5

Glomerulosa= aldosterone
Fasciculata= cortisol

Question 6

Function of aldosterone?

Answer 6

Acts to increase blood volume and blood pressure

It increases the sodium reabsorption into blood and increases potassium excretion from blood

Question 7

Why does adrenal insufficiency result in hyperkalaemia?

Answer 7

Aldosterone increases the sodium reabsorption into blood and increases potassium excretion from blood
THerefore less aldosterone in blood means that there is less potassium pumped out of blood» HYPERKALAEMIA

Question 8

Main primary causes of addisons? (3)

Answer 8

Autoimmune attack of adrenal gland
TB
Carcinoma (metastasis from lungs)

Question 9

At what point do symptoms present?

Answer 9

When around 90% of adrenal tissue is destroyed because adrenals have a good functional reserve

Question 10

Main secondary causes of addisons? (3)

Answer 10

Hypopituitarism» decreased production of

Pituitary apoplexy
Chronic steroid use
Pituitary microadenoma
All of these three cause hypopituitarism

Question 11

Presentation?

Answer 11

Reduced ALDOSTERONE CAUSES:
Hypotension
Hyperkalaemia
Hyponatraemia
Acidosis
Dehydration

REDUCED CORTISOL CAUSES:
Reduced blood glucose especially at times of stress

Question 12

App Ix (2)

Answer 12

Bloods: U&Es» reduced sodium, increased potassium, reduced glucose

Diagnostic: give synthetic ACTH and see if there is a rise in Cortisol&raquo_space; if there is, rule out primary cause of addisons because the adrenals are not damaged

Question 13

2 Mx

Answer 13

Hormone replacement therapy

Hydrocortisone
Aldosterone (synthetic)

Question 14

What is addisonian crisis?

Answer 14

Severe addisons disease which is presented as a severe body reaction when there is a stressor applied to the body and the body’s needs are not met because of a reduced cortisol/aldosterone production

Question 15

Presentation of addisonian crisis? (3)

Answer 15

Shock>> hypotension
Tachycardia
Hypoglycaemia
hyponatraemia
hyperkalaemia

Question 16

To which pt’s does addisonian crisis occur in? (2)

Answer 16

Known addisons disease pt’s

Chronic steroid user

Question 17

Mx of addisonian crisis

Answer 17

Do Ix to check serum cortisol, aldosterone etc
Blood culture to check if it is septic shock instead

IV FLUIDS
IV HYDROCORTISONE AND ALDOSTERONE
TREAT UNDERLYING CAUSE» HORMONE REPLACEMENT

Question 18

What are the signs and symptoms of addisons disease?

Answer 18

Weight loss and loss of appetite 
Weakness 
Light headness 
Low blood pressure 
Skin hyperpigmintation 
Abdo pain and fatigue 
Anxiety and low mood changes 
the need to urinate frequently 
increased thirst 
craving for salty foods 
Dehydration

Question 19

Why do addison patients have hyperpigmentation?

Answer 19

There is less cortisol in blood so there is more need for ACTH production to try and stimulate body to produce more cortisol.
ACTH and Melanocyte stimulating hormone are both produced from proopiomelanocortin
This means that the increased proopiomelanocortin results in raised melanocyte stimulating hormone» leads to increased melanocytes» HYPERPIGMENTATION