Adrenal insufficiency - mx

Question 1

Intial test of hypocortisolism

Answer 1

1. morning serum cortisol levels < 3
2. morning serum ACTH levels
   - high ACTH in primary adrenal insufficiency
   - low ACTH in secondary/tertiary adrenal insufficiency

Question 2

2nd line - confirmation test - (primary adrenal insufficiency)

Answer 2

1. administer exogenous ACTH (Synachten’s test)
2. measure serum cortisol 30 min before and after admin
3. failure to significantly increase in cortisol after ACTH administration

Question 3

2nd line - confirmation test - (secondary/tertiary test)

Answer 3

1. exogenous ACTH

2. increase in cortisol

Question 4

U+E - results

Answer 4

1. low sodium - hyponatremia

2. high potassium - hyperkalaemia

Question 5

TFTs - results

Answer 5

compensated hypothyroidism

1. low thyroid hormone

Question 6

Ix - hypoaldosteronism

Answer 6

high plasma renin concentration

Question 7

Ix - hypoandorgenism

Answer 7

low DHEA- S