(!) Adrenal insufficiency

Question 1

Define Adrenal Insufficiency

Answer 1

Addisons or primary adrenal insufficiency, is a disorder of adrenal glands causing decreased production of steroids and aldosterone
can be caused by destructive process

2ndary adrenal insufficiency is via hypo pit involvement-decreased ACTH

Question 2

Aetiology and risk factors of Adrenal insufficiency

Answer 2

In developed countries, the main cause of Addison’s is autoimmune disorder (80%) attacking the adrenal-once over 80% is destroyed can lead to adrenal insufficiency

In countries with TB-most common cause

Risk factor 
Female sex
Autoimmune diseases
TB
HIV

Question 3

Epidiemology of Adrenal insufficiency

Answer 3

about 140 in 1million in developed countries

14 in 100 000-commonish

Question 4

Signs and Sx of Adrenal insufficiency

Answer 4

In all patients-from lack of cortisol
Fatigue, loss of appetite, Weight loss

from ACTH prod (only in primary/addisons)-hyperpigmentation

Salt craving

Nausea, vomiting,
Hypotension

arthralgia and myalgia

Sx of hyperkalemia

Acute adrenal crisis is a medical emergency caused by a lack of cortisol. Patients may experience lightheadedness or dizziness, weakness, sweating, abdominal pain, nausea and vomiting, or even loss of consciousness/COMA

Question 5

Investigation of adrenal insufficiency

Answer 5

Electrolytes-low Sodium, High potassium
-> dont wait in emergency/crisis

Urea-high
FBC-anemia
Serum 9am morning cortisol-low (when its should peak
ACTH stimulation test-cortisol doesn’t rise
adrenal CT-smol

Question 6

Management of adrenal insufficiency

Answer 6

Need to replace whats missing on diagnosis
Cortisol and aldosterone
(Prednisolone, +fludrocostisone)

Adrenal crisis-IV steroids
Saline for the very low tension

in stress-Increase dose with stress/health issues
with surgery-x3
in major events–IV

Question 7

Complications of Adrenal insufficiency

Answer 7

can get Cushing from overuse of steroids
diabetes

Steroids also cause osteopenia/porosis

can get hypertension from aldosterone

crisis complications-coma
Shock from hypotension
Seizures from low NA

Question 8

Prognosis of Adrenal insufficiency

Answer 8

Need lifelong therapy, but adherence is high (as very Sx without)

some people get long term fatigue