Endocrine Part 1 Flashcards
Chronic Adrenocortical Insufficiency is a disorder in which
the adrenal gland does not produce enough hormones
Secondary adrenocortical insufficiency is when the
pituitary fails to secrete ACTH
Causes of secondary adrenocortical insufficiency
- Exogenous glucocorticoid use (MCC)
- Hypopituitarism
On the other hand, primary adrenal insufficiency is
Adrenal gland destruction, so a lack of cortisol AND aldosterone
True or False: In secondary adrenal insufficiency, there is a lack of cortisol only. The aldosterone is intact because of the renin angiotensin aldosterone system?
True!
Causes of primary adrenal insufficiency
- Autoimmune (MC)
- Infection (TB, HIV)
- Vascular
- Medications (Ketoconazole, Rifampin, Phenytoin)
Symptoms of adrenocortical insufficiency (lack of cortisol)
- Weakness, myalgias, fatigue
- Nonspecific GI symptoms
- Abnormal menstruation
- Mild hyponatremia, salt craving
- Hypotension
Symptoms in Primary (Addison’s Disease) due to lack of sex hormones and aldosterone
- Hyperpigmentation (increased ACTH stimulates melanocytes)
- Orthostatic Hypotension
- Loss of libido, amenorrhea, and loss of pubic hair in women
What do the labs show in Primary Adrenocortical insufficiency?
- Elevated ACTH
- Hyperkalemia, Metabolic Acidosis
What do the labs show for secondary adrenocortical insufficiency
- Decreased ACTH
- Hypoglycemia
What is the screening test for adrenal insufficiency?
- High dose ACTH stimulation test
- -This test is positive if insufficient or absent rise in serum cortisol ( < 18) after ACTH administration
Treatment for adrenal insufficiency
- Glucocorticoid replacement (Hydrocortisone)
- Mineralocorticoid replacement (Fludricortisone) ONLY in Addison’s
What are some patient education tips if they have adrenal insufficiency?
- Patients must be treated with IV glucocorticoids and IV isotonic fluids before and after surgery
- During illness/stress/surgery, oral dosing needs to be adjusted to triple the dose
- Everyone should carry a medical alert tag and injectable form of cortisol
Explain the pathophysiology of Adrenal (Addisonian) Crisis
-Triggered by a stressful event (trauma, illness, surgery) and usually the response is to increase cortisol by three-fold. Patients with this are unable to do so to meet the demand.
Etiologies of Addisonian Crisis
- Abrupt withdrawal of glucocorticoids (without tapering)
- Bilateral adrenal infarction
