Adrenal insufficiency Flashcards

1
Q

define adrenal insufficiency?

A

deficiency of adrenal cortical hormones (e.g. mineralocorticoids, glucocorticoids and androgens)

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2
Q

what is the most common cause of Addison’s disease?

A

autoimmune cause

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3
Q

what is primary adrenal Insufficiency ?

A

this is when the adrenals are not functioning.

ACTH is still being produced

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4
Q

what is secondary adrenal Insufficiency ?

A

this is when there is a depletion of ACTH

the adrenals work normally

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5
Q

what is the main iatrogenic cause of adrenal Insufficiency ?

A

Sudden cessation of long-term steroid therapy

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6
Q

what are the chronic features of addisons?

A
o	Lethargy 
o	Anorexia and weight loss
o	Nausea and vomiting 
o	Salt craving 
o	Hypotension 
o	Hyperglycaemia 
o	Hyponatraemia and hyperkalaemia 

often very vague

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7
Q

what are the acute presentations of addisons?

A

o Shock
o Pyrexia
o Major haemodynamic collapse
o Precipitated by stress (e.g. infection, surgery)

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8
Q

what is the sign of adrenal insufficiency on examination ONLY in primary causes/

A

increased pigmentation

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9
Q

what are the general signs of adrenal insufficiency on examination

A
  • Postural hypotension
  • Increased pigmentation
  • Loss of pubic hair in women
  • Associated autoimmune condition
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10
Q

what are signs of addison ian crisis?

A
o	Hypotensive shock 
o	Tachycardia 
o	Pale  
o	Cold  
o	Clammy  
o	Oliguria
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11
Q

what is the first line investigation for adrenal insufficiency?

A

9am serum cortisol
• > 550 nmol/L makes adrenal insufficiency unlikely
• <100nmol/L is very abnormal

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12
Q

what is the gold standard investigation for addisons?

A
  • IM 250 ug tetrocosactrin (synthetic ACTH)

* Serum cortisol < 550 nmol/L at 30 mins indicates adrenal failure

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13
Q

how to identify the cause of the addisons?

A
o	Autoantibodies (against 21-hydroxylase)  
- autoimmune cause
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14
Q

what investigations should be done in an addisons crisis?

A

o FBC (neutrophilia –> infection)

o U&Es
• High urea
• Low sodium
• High potassium

o	CRP/ESR 
o	Calcium (may be raised) 
o	Glucose - low  
o	Blood cultures  
o	Urinalysis 
o	Culture and sensitivity  
o	Check TFTs
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15
Q

how to manage an addison ian crisis?

A

o Rapid IV fluid rehydration
o 50 mL of 50% dextrose to correct hypoglycaemia
o IV 200 mg hydrocortisone bolus
o Followed by 100 mg 6 hourly hydrocortisone until BP is stable
o Treat precipitating cause (e.g. antibiotics for infection)
o Monitor

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16
Q

how to manage chronic adrenal insufficiency?

A

o Replacement of:
• Glucocorticoids with hydrocortisone
• Mineralocorticoids with fludrocortisone

17
Q

what dose might change when someone with addisons is sick?

A

o Hydrocortisone dosage needs to be doubled during times of acute illness or stress

18
Q

what advice might be given to someone with addisons?

A

o Have a steroid warning card
o Wear a medic-alert bracelet
o Emergency hydrocortisone on hand

19
Q

complication of Addison’s disease?

A

• HYPERKALAEMIA

20
Q

what is the prognosis for patients with adrenal insufficiency?

A
  • Adrenal function rarely recovers

* Normal life expectancy if treated