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Year 4 - Paediatrics > Endo - Adrenal Insufficiency > Flashcards

Endo - Adrenal Insufficiency Flashcards

1
Q

What is adrenal insufficiency?

A

Adrenal glands do not produce enough steroid hormones, cortisol and aldosterone

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2
Q

What is Addison’s disease?

A

Adrenal gland damage causing reduced secretion of cortisol and aldosterone

AKA primary adrenal insufficiency

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3
Q

What is the most common cause of Addison’s disease?

A

Autoimmune

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4
Q

What is secondary adrenal insufficiency caused by?

A

Inadequate ACTH causing low cortisol levels

Due to loss or damage to pituitary gland

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5
Q

What can cause pituitary gland damage?

A

Congenital underdevelopment (hypoplasia)
Surgery
Infection
Loss of blood flow
Radiotherapy

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6
Q

What causes tertiary adrenal insufficiency?

A

Inadequate CRH release by hypothalamus

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7
Q

What causes inadequate CRH release?

A

Long-term oral steroids (over 3 weeks)

Causing hypothalamic suppression

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8
Q

Why do long-term exogenous steroids need to be stopped slowly?

A

Hypothalamus does not wake up fast enough and endogenous steroids not produced

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9
Q

What are the features of adrenal insufficiency in babies?

A

Lethargy
Vomiting
Poor feeding
Hypoglycaemia
Jaundice
Failure to thrive

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10
Q

What are the features of adrenal insufficiency in older kids?

A

Nausea + Vomiting
Poor weight gain or loss
Anorexia
Abdominal pain
Muscle weakness or cramps
Developmental delay or poor academic performance
Bronze hyperpigmentation in Addison’s

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11
Q

What causes bronze hyperpigmentation in Addison’s?

A

Damage to adrenal gland, so adrenals don’t produce enough cortisol and aldosterone

Hypothalamus goes into overdrive and produces lots of ACTH to stimulate cortisol and aldosterone production

POMC is cleaved to produce ACTH and MSH, increased MSH causing stimulation of melanocytes leading to hyperpigmentation

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12
Q

What investigations should all children with suspected adrenal insufficiency have?

A

U&Es - hyponatraemia and hyperkalaemia
Blood glucose - hypoglycaemia

Test for diagnosis with
Cortisol, ACTH, aldosterone and renin levels before giving steroids

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13
Q

What hormone levels would you expect in primary and secondary adrenal failure?

A

Primary
High ACTH
Low cortisol
Low aldosterone
High renin

Secondary
Low ACTH
Low cortisol
Normal aldosterone
Normal renin

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14
Q

What is used to confirm adrenal insufficiency?

A

Short Synacthen Test

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15
Q

When is the short synacthen test performed?

A

In the morning

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16
Q

How should healthy adrenal glands respond to synthetic ACTH?

A

Stimulate cortisol production

Cortisol level should at least double

17
Q

What does a failure of cortisol levels to double in the short synacthen test indicate?

A

Addison’s disease

18
Q

How is adrenal insufficiency managed?

A

Hydrocortisone
Cortisol replacement (glucocorticoid)

Fludrocortisone
Aldosterone replacement (mineralocorticoid)

Steroid card and emergency ID tag to inform emergency services they are steroid dependent

Doubled doses during illness

19
Q

What are kids with adrenal insufficiency monitored for?

A

Growth and development
BP
U&Es
Glucose
Bone profile
Vitamin D

20
Q

What are the Sick Day Rules for steroids?

A

Minor colds or coughs do not require changes

  • Dose of steroid doubled and given more regularly until illness resolved
  • Blood sugar monitored, eat more carbohydrate rich foods more regularly
  • IM injection or IV steroids with diarrhoea or vomiting
21
Q

What is an Addisonian crisis?

A

Acute severe presentation of Addison’s disease, absence of steroid hormones leads to life threatening presentation

22
Q

How do patients with Addisonian crisis present?

A

Reduced consciousness
Hypotension
Hypoglycaemia
Hyponatraemia
Hyperkalaemia

23
Q

What causes an Addisonian crisis?

A

First presentation of Addison’s disease
Infection
Trauma
Acute illness in established Addison’s disease
Abrupt cessation of steroids in long-term steroid users

24
Q

How should an Addisonian crisis be treated?

A

Do not wait for investigations before starting treatment
Intensive monitoring
Parenteral steroids (IV hydrocortisone)
IV fluids
Correct hypoglycaemia
Careful fluid balance
Careful electrolyte balance

Year 4 - Paediatrics (150 decks)

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