Adrenal Insufficiency Flashcards
1
Q
Define adrenal insufficiency
A
Deficiency of adrenal cortical hormones
2
Q
What are the causes/risk factors of adrenal insufficiency?
A
Primary – adrenal • Addison’s disease - Autoimmune >70% - Infection e.g. TB, histoplasmosis, HIV - Infiltration e.g. metastasis, lymphoma, amyloidosis Secondary – pituitary or hypothalamic • Iatrogenic e.g. exogenous steroid use • Pituitary adenoma • Sheehan’s syndrome Tertiary – hypothalamic
3
Q
What are the symptoms of adrenal insufficiency?
A
- Dizziness
- Anorexia
- Weight loss
- Diarrhoea
- Vomiting
- Abdominal pain
- Lethargy
- Weakness
- Depression
Addisonian crisis – often precipitated by stress e.g. infection/surgery • Hypotensive shock • Tachycardia • Pale • Cold • Clammy • Oliguria
4
Q
What are the signs of adrenal insufficiency?
A
- Postural hypotension
- Increased pigmentation – buccal mucosa, scars, skin creases, nails, pressure points
- Loss of body hair
5
Q
What investigations are carried out for adrenal insufficiency?
A
- 9am cortisol <100nmol/L; if 100-550nmol/L -> short synacthen test
- Short synacthen test (250mcg IM ACTH) <550nmol/L
- Serum electrolytes – low sodium, high potassium
- Adrenal antibodies – Addison’s disease (21-hydroxylase)
- Adrenal CT/MRI – atrophy, enlargement, infection, haemorrhage, metastasis
6
Q
What is the management for adrenal insufficiency?
A
Addisonian crisis - treat the precipitating cause!
• IV fluid rehydration - 0.9% saline
• 50ml of 50% dextrose
• IV 200mg hydrocortisone
Chronic adrenal insufficiency
• Hydrocortisone (increase during stress e.g. infection, surgery)
• Fludrocortisone
• Steroid warning card/patient education
7
Q
What are the complications of adrenal insufficiency?
A
- Hyperkalaemia
* Death (Addisonian crisis)
