Adrenal Insuffiency Flashcards

1
Q

What is adrenal insuffiency?

A

Where the adrenal glands do not produce enough of the steroid hormones cortisol and aldosterone

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2
Q

What is primary adrenal insuffiency?

A

Where damage to the adrenal glands results in a lack of cortisol and aldosterone

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3
Q

What is the most common cause of primary adrenal insuffiency?

A

Autoimmune conditions

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4
Q

What is secondary adrenal insuffiency?

A

A lack of ACTH leads to a lack of stimulation of the adrenal glands, and less cortisol.

It is usually as a result of damage to the pituitary gland

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5
Q

What is tertiary adrenal insufficiency?

A

Tertiary adrenal insufficiency is a result of a lack of CRH (corticotrophin releasing hormone) from the hypothalamus

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6
Q

What is the most common cause of tertiary adrenal insufficiency?

A

Long term steroid use causes suppression of the hypothalamus

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7
Q

Why does tertiary adrenal insufficiency occur with long term steroid use?

A

When steroids are withdrawn, the hypothalamus cannot make endogenous steroids quick enough

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8
Q

What is the presentation of adrenal insufficiency?

A

Fatigue
Muscle weakness
Muscle cramps
Thirst and salt craving
Dizziness
Weight loss
Abdominal pain
Depression

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9
Q

What are the physical signs of adrenal insufficiency?

A

Bronze pigmented skin
Hypotension (specifically postural hypotension

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10
Q

Why does adrenal insufficiency cause bronze pigmented skin?

A

Excessive ACTH stimulated melanocytes to produce melanin

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11
Q

What biochemical findings may be seen in adrenal insufficiency?

A

Hyponatraemia
Hyperkalaemia
Hypoglycaemia
Raised creatinine and urea (dehydration)
Hypercalcaemia

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12
Q

What is the investigation of choice for diagnosis of adrenal insufficiency?

A

Short synacthen test

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13
Q

What antibodies may be present in primary adrenal insufficiency?

A

Adrenal cortex antibodies
21-hydroxylase antibodies

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14
Q

How is the short synacthen test performed?

A

Synthetic ACTH (synacthen) is given - blood cortisol is tested after 30 and 60 minutes

Failure of cortisol levels to double indicates primary adrenal insufficiency (or secondary insufficiency that has caused significant adrenal atrophy)

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15
Q

What is the first line management of adrenal insufficiency?

A

Hydrocortisone to replace cortisol
Fludrocortisone to replace aldosterone

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16
Q
A