adrenal insufficiency

Question 1

primary AI cause

Answer 1

• addison disease, most commonly autoimmune (anti-21-hydroxylase antibodies).
• infectious (TB, CMV, histoplasma)
• cancer metastasis
• bilateral adrenal hemmorhage (N. meningitidis, DIC, anticoagulation)

Question 2

secondary AI cause

Answer 2

-meds: suppress pituitary axis, CORTICOSTEROIDS, opioids,

Question 3

history/exam

Answer 3

• weakness, fatigue, anorexia, hypotension, n/v/ abdominal pain
  1: hyperpigmentation at mucous membranes, creases, pressure areas
  2: s/sx of hypopituitarism (hypogonad, hypothyroid, elevated prolactin)

Question 4

labs

Answer 4

cortisol measured in cosyntropin stimulation test

Test admin:

• draw serum ACTH and cortisol
• admin cosyntropin (ACTH analogue) 250ug IV/IM
• draw cortisol 30 and 60 min later

REFER

Question 5

treatment

Answer 5

1. endocrinology referral
2. Acute AI: ED, fluids, steroid replacement
3. Chronic AI
   - titrate dose to s/sx, counsel adherence/sick day rule
   - hydrocortisone 15-25mg daily in 2-3 divided dose OR prednisone 3-5mg qam