Adrenal insufficiency Flashcards
What is adrenal insufficiency?
Where the adrenal glands do not produce enough steroid hormones. particularly cortisol and aldosterone.
What is Addison’s disease?
Refers to the specific condition where the adrenal glands have been damaged resulting in the secretion of cortisol and aldosterone. The is called primary adrenal insufficiency and is most commonly autoimmune
What is secondary adrenal insufficiency?
the result of inadequate ACTH stimulating the adrenal glands resulting in low cortisol release. This is a result of loss or damage to the pituitary gland. This can be due to surgery, infection or radiotherapy
What is Sheehan’s syndrome ?
Where massive blood loss during childbirth leads to pituitary gland necrosis
What is tertiary adrenal insufficiency?
the result of inadequate CRH release by the hypothalamus. This is usually the result of long term oral steroid use. Long term steroids should be tapered slowly to allow time for the adrenal axis to regain normal function
What are the symptoms of adrenal insufficiency?
fatigue nausea cramps abdominal pain reduced libido
What are the signs of adrenal insufficiency?
Bronze hyperpigmentation to skin (ACTH stimulates melanocytes to produce melanin)
Hypotension (particularly postural hypotension _
What investigations should be carried out?
Hyponatraemia Hyperkalaemia Early morning cortisol (often false negative) short synacthen test ACTH levels (high in primary. low in secondary) Adrenal autoantibodies CT/MRI adrenals MRI pituitary
Describe the short Synacthen test
It is ideally performed in the morning
Synthetic ACTH is given. Blood cortisol is measured at baseline, 30 and 60 minutes after administration. The synthetic ACTH will stimulate healthy adrenals to produce cortisol and levels should at least double. Failure of this indicates primary adrenal insufficiency
What is the treatment of adrenal insufficiency?
Replacement of steroids titrated to signs, symptoms and electrolytes
Hydrocortisone is a glucocorticoid hormone to replace cortisol
Fludrocortisone is a mineralocorticoid hormone used to replace aldosterone
What is an addisonian crisis?
The term used to describe an acute presentation os severe Addison’s, where the absence go steroid hormones leads to a life threatening presentation
What is the presentation go an adrenal crisis?
reduced conciousness
Hypotension
hypoglycaemia, hyponatraemia and hypercalcaemia
Patients can be very unwell
What is the management of an addisonian crisis?
Intensive monitoring if unwell
parenteral steroids (IV hydrocortisone 100mg stat the 100mg every 6 hours)
IV fluid resuscitation
Correct hypoglycaemia
Careful monitoring of electrolytes and fluid balance
