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TCD 16 - Obesity > Adrenal Insufficiency > Flashcards

Adrenal Insufficiency Flashcards

1
Q

What is Addison’s disease/primary adrenal insufficiency?

A

The adrenal glands have been damaged, resulting in a reduction in secretion of cortisol and aldosterone

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2
Q

What is Addison’s disease/primary adrenal insufficiency most commonly caused by?

A

Developed world
- Autoimmune

Worldwide
- TB

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3
Q

What is secondary adrenal insufficiency?

A

Inadequate ACTH stimulating the adrenal glands, resulting in low cortisol release

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4
Q

What is secondary adrenal insufficiency caused by?

A

Damage to pituitary gland

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5
Q

What is tertiary adrenal insufficiency?

A

Inadequate CRH release by the hypothalamus

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6
Q

What is tertiary adrenal insufficiency caused by?

A

Long-term oral steroids causing suppression of the hypothalamus

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7
Q

What are the symptoms of adrenal insufficiency?

A
  • Fatigue
  • Nausea
  • Cramps
  • Unexplained Abdominal pain or vomiting
  • Reduced libido
  • Anorexia
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8
Q

What are the signs of adrenal insufficiency?

A
  • Bronze hyperpigmentation to skin (only in Addison’s)

* Hypotension

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9
Q

What investigations do you do for adrenal insufficiency?

A
  • U+Es
  • Glucose
  • Early morning cortisol
  • Short synacthen test
  • ACTH
  • Adrenal autoantibodies
  • CT/MRI adrenals
  • MRI pituitary
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10
Q

What might U+Es show with adrenal insufficiency?

A
  • Hyponatraemia
  • Hyperkalaemia

Due to a decrease in aldosterone

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11
Q

What might glucose show with adrenal insufficiency?

A

Decreased

- Due to decrease in cortisol

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12
Q

What is the short synacthen test?

A

Given Synthetic ACTH to stimulate adrenal glands to produce cortisol
- In healthy people the cortisol level should rise

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13
Q

What might the short synacthen test show with adrenal insufficiency?

A

Failure to rise

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14
Q

What does ACTH indicate in adrenal insufficiency?

A

o Primary adrenal failure = high

o Secondary adrenal failure = low

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15
Q

What antibodies do you look for in adrenal insufficiency?

A

o Adrenal cortex antibodies

o 21-hydroxylase antibodies

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16
Q

How do you treat adrenal insufficiency?

A

• Hydrocortisone
Replaces cortisol

• Fludrocortisone
Replaces aldosterone

17
Q

How do people with an adrenal/Addisonian crisis present?

A
  • Reduced consciousness
  • Hypotension
  • Hypoglycaemia
  • Hyponatraemia
  • Hyperkalaemia
  • Unwell
18
Q

What test would you do for a suspected adrenal/Addisonian crisis?

A
  • Random serum cortisol

- Plasma ACTH

19
Q

How do you manage an adrenal/Addisonian crisis?

A 
Treat before tests are back
•	Hydrocortisone
o	100mg IV STAT , then 100mg every 6 hours
•	IV saline
o	2-3L first hour, then 3-4L per day
o	Supplement salt and water loss

TCD 16 - Obesity (7 decks)

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