B5.034 - Prework 2 - Adrenal Insufficiency Flashcards
what is clinical AI
hypofunction of the adrenal cortex
causes of AI
destruction of adrenal gland (addisons) lack of ACTH autoimmune destruction of adrenal gland (80%) most common
etiology of AI
Autoimmune
infection (viral, TB, AIDS)
hemorrhage
metastasis
infilatrative disorders (Sarcoidosis, amyloidosis)
demylination
adrenoleukodystrophy
what is secondary AI
a result of adrenal gland atrophy from ACTH deficiency
often from pituitary cortocotroph atrophy owing to previous exogenous glucocorticoid use
panhypopituitarism
isolated ACTH deficiency
gold standard for dx of adrenal insufficiency
ACTH stimulation test
a rise in cortisol level to 18 or change in 9 is normal
how do you determine primary vs secondary cause of AI
ACTH level
describe ACTH levels in primary and secondary AI
in primary ACTH is high
in secondary ACTH is low
therapy for acute AI
IV fluids
high dose IV glucocorticoids
treatment of chronic AI
physiologic oral glucocorticoid replacement (hydrocortisone)
Pt education
when pt with AI is ill what do you do
tell them to double the current steroid use for 3 days
if AI patient is going to have major surgery
change to IV steroids like hydrocortisone IV during time of critical illness
pharmacodynamics of glucocorticoids
all receptors interact with promoters and regulate transcription of target genes
physiologic effect of cortisol
affects vascular and bronchial smooth muscles with relationship to catecholamines
in the absence of cortisol there is vasodilation and hypotension
what do glucocorticoids do
stimulate gluconeogenesis and glycogen snythesis in a fasting state
increase serum glucose by inhibiting uptake of glucose in muscle
also stimulates hormone sensitive lipase and thus lipolysis
what is hydrocortisone
short acting steroid
recommended one in morning once in early afternoon
mimics diurnal rhythm the best
