Endocrinology

Question 1

Define Addison’s disease

Answer 1

Primary adrenal insufficiency whereby the adrenal glands have been damaged so there is a reduction in the production of cortisol and aldosterone hormones.

Question 2

What is the common cause of Addison’s disease?

Answer 2

Autoimmune

Question 3

Describe Secondary Adrenal Insufficiency

Answer 3

Pituitary gland does not produce sufficient ACTH to stimulate the adrenal glands

Question 4

What can cause Secondary Adrenal Insufficiency?

Answer 4

Surgery - removal of pituitary gland
Infection
Loss of blood flow 
Radiotherapy
Sheenan's syndrome

Question 5

What is Sheenan’s syndrome?

Answer 5

Massive blood loss during childbirth –> pituitary gland necrosis

Question 6

Describe Tertiary Adrenal Insufficiency

Answer 6

Long-term use of exogenous steroids (>3 weeks) causes inadequate release of CRH from the hypothalamus

Question 7

What are symptoms of adrenal insufficiency?

Answer 7

Fatigue
Nausea
Cramps
Abdominal pain
Reduced libido

Question 8

What are the signs of adrenal insufficiency?

Answer 8

Bronzed hyperpigmentation of the skin (ACTH –> stimulates melanocytes –> increased melanin)
Postural hypotension

Question 9

What are the key investigations in assessing a patient with ? adrenal insufficiency?

Answer 9

U&Es (low Na, high K)
Short SynACTHen Test
Cortisol Levels
Antibodies

Question 10

What antibodies are associated with primary adrenal insufficiency?

Answer 10

Adrenal cortex antibodies

21-hydroxylase antibodies

Question 11

Describe the Short SynACTHen test

Answer 11

Give synacthen in the morning
Measure baseline cortisol
Cortisol at 30 mins and 60 mins

Cortisol levels should >2x baseline

If Primary Adrenal Insufficiency then cortisol levels do not rise appropriately <2x baseline

Question 12

What ACTH levels would be expected if a patient had primary adrenal insufficiency?

Answer 12

High

Question 13

What ACTH levels would be expected if a patient had secondary adrenal insufficiency?

Answer 13

Low

Question 14

What drugs are used in the management of Primary Adrenal Insufficiency

Answer 14

Hydrocortisone (replace cortisol)

Fludrocortisone (replace aldosterone)

Question 15

What is an Addisonian Crisis?

Answer 15

Acute presentation of severe Addisons

Question 16

How does a patient present with an Addisonian crisis?

Answer 16

Reduced consciousness
Hypotension
Hypoglycaemia, hyponatraemia, hyperkalaemia

Question 17

What can trigger an Addisonian Crisis?

Answer 17

Infection
Trauma
Acute illness

Question 18

How should an Addisonian Crisis be managed?

Answer 18

Intensive care input if unwell
Parental steroids (IV hydrocortisone 100mg stat then 100mg every 6 hours)
IV fluid resuscitation
Correct hypoglycaemia
Monitor electrolytes and fluid balance

Question 19

How can DKA be diagnosed?

Answer 19

Hyperglycaemia (BM >11.0)
Ketosis (blood ketones > 3)
Acidosis (pH <7.3)