Adrenal insufficiency

Question 1

What is adrenal insufficiency and Risk factors

Answer 1

Inadequate production of cortisol due to supression of the AXIS –usually a result from overuse of steroids before hand – can be iatrogenic or NOT
Whole axis is supressed- CRH, ACTH and Cortisol
eg: “50 y/o female 2y on steroids stops and suddently dizzy and low BP”

Risk factors -
History of supraphysiological steroid exposure for a long time
Either- regular oral steroids(eg inflam disease,) OR eye drops, Nasal sprays, Inhalers and Injections!
Or cushingoid features (iatrogenic or not)

and add RECENT CESSATION/Tapering
OR NEW ILLNESS with no increase in dose

ALSO REMEMBER- any steroid user should DOUBLE their dose if small illness, minor surgery for the duration of stress

Question 2

Presentation of adrenal insufficiency and Ix

Answer 2

Adrenal Crisis– Acute circulatory collapse– pretty much hypotension and tachycardia, postural hypotension, etc

other more chronic sx- Lassitude, tiredness, fatigue, weight loss, N&V
then other signs of steroids use- weight gain, cushinoig, diabetes,
ABSENCE OF HYPERPIGMENTATION (which would mean addisons)

its mainly in the hx- use of steroids recently stopped

find clues on bloods-
Hypo/hyperglycemia
Hypokalemia, hypomagnesemia
alkalosis

careful- the classic hyperkalemia/hyponatremia isnt present because Renin system intact

Question 3

Management of adrenal Insufficiency and Adrenal Crisis

Answer 3

Adrenal crisis is an emergency as it leads to hypovalemic shock and death–
Give immediate IV hydrocortisone (or IM), then continue infusion- decrease when pt improves
IV fluids- dextreose
and search for precipitating factor (often infection)
NO NEED FOR MINERALOCORTICOID replace as RAAS system intact

ALSO REMEMBER- any steroid user should DOUBLE their dose if small illness, minor surgery for the duration of stress
Big stress–parenteral steroids

Question 4

what should someone taking steroids do during a small illness/stress? and a large one?

Answer 4

ALSO REMEMBER- any steroid user should DOUBLE their dose if small illness, minor surgery for the duration of stress
Big stress–parenteral steroids