Case Questions

Question 1

What is the gold standard test when sodium levels fall and potassium levels rise?

Answer 1

short SynACTHen test

Question 2

SynATCHen test - when is serum cortisol normal?

Answer 2

greater than 500nmol/l

Question 3

three steps in the synACTHen test:

Answer 3

Measure an early morning (before 9am) baseline cortisol and ACTH

Give a dose of synthetic ACTH (IV or IM)

Measure serum cortisol 30 minutes later

Question 4

serum cortisol below 500nmol/l is indicative of:

Answer 4

adrenal insufficiency

Question 5

primary adrenal insufficiency is lack of

Answer 5

adrenal hormones

Question 6

secondary adrenal insufficiency

Answer 6

loss of precursor hormones (like ACTH)

Question 7

How do you work out if it is primary or secondary adrenal insufficiency?

Answer 7

High baseline ATCH - primary (addison’s)

Low baseline ACTH = secondary

Question 8

adrenal hypofunction is due to a lack of

Answer 8

ACTH

Question 9

how can you investigate for possible causes of Addison’s?

Answer 9

measure serum antibodies (anti 21-hydroxylase)

MRI adrenals (atrophy/ tumours)

Screen for rarer causes (TB/HIV etc)

Question 10

How would you manage Addison’s?

Answer 10

hydrocortisone (glucocorticoid replacement)

fludrocortisone (mineralocorticoid replacement)

Patient eduction