circadian rhythms, adrenal insufficiency and management Flashcards
describe the HPA axis
hypothalamus -> CRH
anterior pituitary -> ACTH
adrenal cortex -> cortisol
define circadian rhythmns
physical, mental and behavioural changes that follow a daily cycle.
what is adrenal insufficiency
A condition in which the adrenal glands do not produce adequate amounts of steroid hormone (mainly cortisol).
primary adrenal insuffiency
Addison’s Disease
secondary adrenal insufficiency
Hypopituitarism
tertiary adrenal insuffiency
Suppression of HPA
symptoms of adrenal insufficiency
Fatigue
Weight loss
Poor recovery from illness
Adrenal crisis
Headache
what to ask regarding past history to diagnose adrenal insuffiency
TB
Post partum bleed
Cancer
what to ask regarding family history to diagnose adrenal insuffiency
Autoimmunity
Congenital disease
treatment of adrenal insuffiency
any steroids
signs of adrenal insuffiency
Pigmentation and pallor
Hypotension
biochemisty of adrenal insufficy
Low Na, high K
Eosinophilia
Borderline elevated TSH
causes of primary adrenal insuffiency
Adrenal antibodies
Very long chain fatty acids
Genetic
causes of secondary adrenal insufficncy
Any steroids
Imaging
Genetic
specific treatment of adrenal insuffiency
Goal: mirror the normal physiological state
Replace aldosterone with fludrocortisone (primary AI)
Hydrocortisone 2/3 times daily
