Adrenal Insuficiency

Question 1

What are the symptoms of primary adrenal insuficiency?

Answer 1

“NAAW SHHHH adrenal gland”
*Nausea,vomiting,diarrhea , constipation, abdominal pain,
Weight loss
Anorexia
*Hyponatremia
*Hypovolemia/hypotension
*Hyperkalemia
Hypercalcemia
Acidosis(high H+)
Anemia
Azotemia
+
Fatigue
Salt craving
*Postural dizziness
*Hyperpigmentation
Vitiligo(loss of pigmentation)

Question 2

What is the most common etiology of addison’s ?

Answer 2

Autoimmunity

Question 3

What are the levels of ACTH in primary adrenal insufficiency ?

Answer 3

High ACTH—>hyperpigmentation

Question 4

Who do you suspect adrenal insufficiency in?

Answer 4

Pt who used Predinol(corticosteroid) for 3 months then suddenly stops it will suffer from adrenal crisis

Question 5

What indicates that there’s an overdose in the treatment of adrenal insufficiency ?

Answer 5

Symptoms of cushing syndrome

Question 6

What is the tx for adrenal insufficiency ?

Answer 6

Steroids and mineralocorticoids

Question 7

What are the levels of cortisol and aldosterone in primary adrenal insufficiency ?

Answer 7

Low cortisol and aldosterone

Question 8

How do you differentiate between primary and secondary/tertiary adrenal insufficiency ?

Answer 8

In primary:
Dysfunction in the adrenal gland,
U observe low cortisol and aldosterone and high ACTH+hyperpigmentation, hypotension, hyperkalemia, dehydration, hyponatremia

In secondary:
Dysfunction in the hypothalamus or pituitary,
Low cortisol, low or normal ACTH and aldosterone only.

Question 9

What is the gold standard test for diagnosing adrenal insufficiency ?

Answer 9

Insulin tolerance test:

• The test is based on the evaluation of serum cortisol levels measured during hypoglycemia that occurs after 8–10 hours of fasting(in morning) and IV administration of 0.1–0.15 U/kg insulin
• During hypoglycemia, cortisol levels are expected to rise above 18–20 μg/dl