B5.034 Adrenals Flashcards
discuss the presentation of AI
60% of patients have to see >2 physicians to get a correct diagnosis
may become acutely ill when they experience significant illness or infection (which can precipitate adrenal crisis)
characteristics of a patient with addisons disease (primary AI)
bronze skin changes in distribution of body hair GI disturbances weakness hypoglycemia postural hypotension weight loss
adrenal crisis
profound fatigue dehydration vascular collapse renal shut down decreased serum Na increased serum K
symptoms specific to primary AI
salt craving
pigmentation of sin and mucous membranes (excess ACTH)
chronic AI syndrome symptoms
weakness, fatigue, anorexia, nausea, abdominal pain, diarrhea, occasional orthostatic hypotension, weight loss
acute AI syndrome symptoms
muscle, joint, abdominal pain postural hypotension fever clouded thinking no hyperpigmentation
differential diagnosis of adrenal insufficiency
primary: elevated ACTH, adrenal CT, associated mineralocorticoid deficiency
secondary: normal or low ACTH in setting of low cortisol, do a head MRI
number one cause of primary AI
70% in industrialized world due to polyendocrine deficiency syndrome associated with other autoimmune diseases
polyglandular autoimmune syndrome type I
hypoparathyroid, onset childhood AI, mucocutaneous candidiasis (HAM)
also can have hypogonadism, pernicious anemia, chronic active hepatitis, alopecia
polyglandular autoimmune syndrome type II
onset young adult AI
autoimmune thyroid disease
DM1
worldwide leading cause of AI
tuberculosis
other causes of AI
fungi (histo) metastatic cancer AIDS waterhouse- friederichson syndrome rare amyloidosis, carcoidosis, adrenal hemorrhage, congenital adrenal hyperplasia, adrenoleukodystrophy, adrenomyeloneuropathy
causes of seconday AI
adrenal suppression after exogenous GC and more recently long term narcotic use
