Adrenal Insuffiency

Question 1

what

Answer 1

adrenal glands don’t produce enough steroid hormones

Question 2

Addison’s disease

Answer 2

adrenal glands damaged
primary adrenal insufficiency

often autoimmune

Question 3

secondary adrenal insufficiency

Answer 3

inadequate ACTH stimulating adrenal glands

loss or damage of pituitary gland

Question 4

tertiary adrenal insufficiency

Answer 4

inadequate CRH from hypothalamus

usually when exogenous steroids suddenly withdrawn + hypothalamus doesn’t wake up fast enough

Question 5

features

Answer 5

fatigue 
nausea
cramps 
abdo pain 
reduced libido 
bronze hyperpigmentation 
hypotension

Question 6

sodium leevls

Answer 6

low

Question 7

potassium levels

Answer 7

high

Question 8

ACTH in primary adrenal failure

Answer 8

high - pituitary trying hard to stimulate adrenal glands without any negative feedbac

Question 9

ACTH in secondary adrenal failure

Answer 9

low

Question 10

adrenal autoantibodiees

Answer 10

adrenal cortex antibodies

21-hydroxylase antibodies

Question 11

short synacthen test

Answer 11

giving synacthen (synthetic ACTH), blood cortisol measured at baseline then 30 min and 60min after admin

Question 12

short synacthen test - normal result

Answer 12

synthetic ACTH will stimulate adrenals to produce cortisol and cortisol should at least double

Question 13

short synacthen test - result indicating addison’s disease

Answer 13

failure of cortisol to rise (less than double baseline)

Question 14

treatment

Answer 14

hydrocortisone

fludrocortisone

Question 15

steroid doses during acute illness

Answer 15

doubles until recovered

Question 16

Addisonian crisis

Answer 16

acute presentation of severe addison’s

absence of steroid hormones leads to life threatening presentation

Question 17

Addisonian crisis - presentation

Answer 17

reduced conscioisness
hypotension 
hypoglycamia
hyponatraemia
hyperkalaemia

Question 18

Addisonian crisis - Mx

Answer 18

parenteral steroids e.g. IV hydrocortisone
IV fluid resus
correct hypoglycaemia