Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Acute Care & Trauma > Adrenal Insufficiency > Flashcards

Adrenal Insufficiency Flashcards

1
Q

What is Adrenal Insufficiency?

A

Deficiency of adrenal cortical hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some examples of adrenal cortical hormones?

A

Mineralocorticoids

Glucocorticoids

Androgens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some of the causes and risk factors of adrenal insufficiency?

A

Primary Adrenal Insufficiency

Secondary Adrenal Insufficiency

Infections

Infiltration

Infarction

Inherited

Surgical
Iatrogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some examples of a Primary Adrenal Insufficiency?

A

Addison’s Disease (usually autoimmune)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some examples of Secondary Adrenal Insufficiency?

A

Pituitary or Hypothalamic Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some examples of infections?

A

Tuberculosis

Meningococcal septicaemia (Waterhouse-Friderichsen Syndrome)
CMV
Histoplasmosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some examples of Infiltration?

A

Metastasis (mainly from lung, breast, melanoma)

Lymphomas

Amyloidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is an example of an Infarction cause of adrenal insufficiency?

A

Secondary to thrombophilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is an inherited cause of Adrenal Insuffiency?

A

Adrenoleukodystrophy

ACTH receptor mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a surgical cause of Adrenal Insuffiency?

A

After bilateral adrenalectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the Iatrogenic cause of adrenal insuffiency?

A

Sudden cessation of long term steroid therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the epidemiology of adrenal insufficiency?

A

Most common cause is IATROGENIC

Primary causes are rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the chronic presentation of adrenal insufficiency?

A

Dizziness

Anorexia

Weight Loss

Diarrhoea and Vomiting

Abdominal Pain

Lethargy

Weakness

Depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the acute presentation of adrenal insufficiency (Addisonian Crisis)?

A

Acute Adrenal Insufficiency

Major Haemodynamic Collapse

Precipitated by stress (e.g. infection, surgery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the signs of adrenal insufficiency on physical examination?

A
  • Postural Hypotension
  • Increased pigmentation
    • More noticeable on buccal mucosa, scars, skin creases, nails and pressure points
  • Loss of body hair in women (due to androgen deficiency)
  • Associated autoimmune condition (e.g. vitiligo)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the signs of Addisonian Crisis?

A

Hypotensive Shock

Tachycardia

Pale

Cold
Clammy

Oliguria

17
Q

What are some of the investigations for adrenal insufficiency?

A

To confirm the diagnosis

Identify the level of the defect in the hypothalamo-pituitary-adrenal axis

Identify the Cause

Check TFTs

18
Q

How do you confirm the diagnosis for adrenal insufficiency?

A
  • 9 am Serum Cortisol (< 100 nmol/L is diagnostic of adrenal insufficiency)
    • >550 nmol/L makes adrenal insufficiency unlikely
  • Short Synacthen Test
    • IM 250 µg tetrocosactrin (synthetic ACTH)
    • Serum cortisol < 550nmol/L at 30 mins indicates adrenal failure
19
Q

How do you identify the level of the defect in the hypothalamo-pituitary-adrenal axis?

A
  • HIGH in primary disease
  • LOW in secondary
  • LONG SYNACTHEN TEST
    • 1 mg synthetic ACTH administered
    • Measure serum cortisol at 0, 30, 60, 90 and 120 minutes
    • Then measure again at 4, 6, 8, 12 and 24 hours
    • Patients with primary adrenal insufficiency show no increased after 6 hours
20
Q

How do you identify the cause of adrenal insufficiency?

A

Autoantibodies (against 21-hydroxylase)

Abdominal CT or MRI

Other tests (adrenal biopsy, culture, PCR)

21
Q

What investigations would you do for Addisoninan Crisis?

A
  • FBC (neutrophilia –> infection)
  • U&Es
    • High Urea
    • Low Sodium
    • High Potassium
  • CRP/ESR
  • Calcium (may be raised)
  • Glucose - low
  • Blood Cultures
  • Urinalysis
  • Culture and Sensitivity
22
Q

What is the management plan for adrenal insufficiency?

A

Rapid IV fluid rehydration

50 mL of 50% dextrose to correct hypoglycaemia

IV 200 mg hydrocortisone bolus

Followed by 100 mg 6 hourly hydrocortisone until BP is stable

Treat precipitating cause (e.g. antibiotics for infection)

Monitor

23
Q

What is the management for Chronic Adrenal Insufficiency?

A
  • Replacement of:
    • Glucocorticoids with hydrocortisone (3/day)
    • Mineralocorticoids with fludrocortisone
  • Hydrocortisone dosage needs to be increased during times of acute illness or stress
  • If the patient also has hypothyroidism, give hydrocortisone BEFORE thyroxine
24
Q

What advice can you get for adrenal insufficiency?

A

Have a steroid warning card

Wear a medic-alert bracelet

Emergency Hydrocortisone on hand

25
Q

What are the possible complications of adrenal insufficiency?

A

Hyperkalaemia
Death during Addisonian Crisis

26
Q

What is the prognosis for patients with adrenal insufficiency?

A

Adrenal function rarely recovers

Normal life expectancy if treated

27
Q

What is Autoimmune Polyendocrine Syndrome?

A

Type 1 - autosomal recessive disorder caused by mutations in the AIRE gene

Consists of the following diseases:

  • Addison’s Disease
  • Chronic Mucocutaneous Candidiasis
  • Hypoparathyroidism

Type 2 - also known as Schmidt’s Syndrome

  • Addison’s Disease
  • Type 1 Diabetes
  • Hypothyroidism
  • Hypogonadism

Acute Care & Trauma (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions