Adrenal insufficiency Flashcards
Primary
Secondary
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Addison’s
bilateral destruction of all zones in the adrenal cortex (medulla is usually spared)
autoimmune polyglandular syndrome
type 1- hypoparathyroid candidiasis, alopecia
type 2: T1DM, autoimmune thyroid, HLA types, pernicious anaemia, vitiligo
infection- TB, aids, fungal
metastasis
haemorrhage
Addison’s clinical features
TATT and lethargy prolonged ill health weight loss mild hypotension nausea hyponatraemia shock and water depletion hyper pigmentation (increased ACHT) confusion or mental slowing
adrenal insufficiency associated disorders
primary- hyperpigentation, hyperkalaemia, vitiligo, autoimmune thyroid disease
secondary - pale skin, amenorrhea, scanty hair, small testicles, secondary hypothyroidism, diabetes insipidus.
investigation for suspected Addison’s
SynACTH-en test
baseline cortisol 9am
inject synacethen (synthetic ACTH) 250ug test IV or IM
take another at 30 min and 60min
normal plasma cortisol increases by 200nmol/L or up to 580nmol/L
SSt should not be reformed on patient receiving hydrocortisone or prednsiolone due to cross reaction with cortisol assay
congenital adrenal hyperplasia
more sex hormones
baby will present with increased entitalia
inefficient cortisol synthesis signals the hypothalamus and pituitary to increase CRH and ACTh so the adrenal glands becomes hyperplastic
inherited disorder (21- hydroxyls deficiency) ambitious genitalia and salt wasting
low aldosterone with salt depletino
hyponatraemia and hypokalaemia
treatment:
accurate replacement of glucocrticoid and mineralocorticoids
conn’s syndrome
excess mineralocorticoid
renin is excreted in response to low sodium but in conn’s the aldosterone is inappropriately high and not suppressible.
hypokalaemia
how to investigate Conn’s
hypertension hyperkalaemia metabolic alkalosis resistant HTN imaging- adenoma in the adrenal
morning blood sample plasma aldosterone conc plasma renin (activity. conc)
high aldosterone, low renin, high aldosterone/ renin ratio
adrenal failure
plasma cortisol concentration increases in response to ACTH
