Adult Adrenal Insufficiency

Question 1

What is primary Adrenal insufficiency?

Answer 1

• Addisons disease
• Congenital Adrenal Hyperplasia

Question 2

What is Secondary Adrenal Insufficiency?

Answer 2

Prolonged steroid therapy at any point wihtin the last 12 months
- Impairment of pituitary or hypothalamic adrenocorticotropic hormone thus reducing steroid release

Question 3

What are some S/S of Adrenal Insurfficiency/Crisis?

Answer 3

• Cardiovascular: Hypotension
• Neurological: Altered conscious state, delirium, seizure
• Fatigue: Severe weakness (e.g. inability to walk)
• Gastrointestinal: Severe abdominal pain, Severe vomiting/diarrhoea
• Hypoglycaemia

Question 4

PAI: potential insufficiency

Answer 4

• Trauma, including large deep laceration, fracture, MVA
• Probably infection/sepsis, febrile illness >38.5degrees
• Recent surgery
• Labour
• Extreme emotional stress
• Acute illness, including diarrhoea and vomiting
• MI
• Environmental exposure/hot weather

Question 5

Initial management for Adrenal insufficiency

Answer 5

• Hydrocortison 100mg IM/IV (if delay in IV provide IM)
• Normal Saline 1000mL IV (if Major trauma mx as per Major trauma)
• If perfusion borderline provide further 1000mL

Question 6

What is a Tx consideration for Adrenal Insufficiency?

Answer 6

• Hospital with ICU

Question 7

What are the care objectives for Adrenal Insufficiency?

Answer 7

• Prioritise corticosteroid therapy
• Support perfusion with IV fluid
• Transport to closest hospital preferable with ICU

Question 8

What conditions are managed with prolonged steroid use?

Answer 8

• Athma
• COPD
• Rheumatic disease
• IBD
• Vasculitis
• Organ transplantation

Question 9

What doses of steroids are patients likely to experience SAI?

Answer 9

• > 20mg/day of Pred (or equivalent dose of other steroid) for more than 3 weeks
• Evening/bedtime dose of >= 5mg of pre for more than a few weeks
• Patients with a cushingoid appearance