FN: Adrenal Insufficiency Flashcards
1
Q
Primary Adrenal insufficiency
A
Addison’s
2
Q
Addisons disease
A
Destruction of adrenal cortex –> glucocorticoid and mineralcorticoid deficiency
3
Q
Causes of Addisins
A
- Autoimmune destruction: 80% in the UK
- TB: commonest worldwide
- Metastasis: lung, breast, kidneys
- Haemorrhage: waterhouse-Friedrichson
- Congenital
4
Q
Symptoms of adrenal insufficiency
A
- Wt. loss + anorexia
- n/v, abdo pain, diarrhoea/constipation
- Lethargy, depression
- Hyperpigmentation: buccal mucosa, palmer creases
- Postura hypotension –> dizziness, faints
- Hypoglycaemia
- Vitiligo
- Addisonian crisis
5
Q
Investigations
A
Bloods
Differential
Other
6
Q
Bloods show
A
Hyponatraemia/ Hyperkalaemia
REduce glucose
Reduced Caclium
Anaemia
7
Q
Differential by using which tests
A
Short synACTHen test
8
Q
SynACTH test
A
Cortisol before and after tetracosactide
Exclude Addison’s if raised cortisol
if 9am ACTH (usually low)
9
Q
Other investigations
A
- 21-hydroxylase Abs: _ve in 80% of AI disease
- Plasma renin and aldosterone
- CXR: evidence of TB
- AXR: adrenal calcification
10
Q
Treatment
A
- Replace
- Advice
- Follow up
11
Q
Repace
A
Hydrocortisone
Fludrocortison
12
Q
Advice
A
- Dont stop steroids suddenly
- Increase steroids during intercurrent illness, injury
- Wear a medic-alert bracelet
13
Q
Secondary adrenal insufficiency
A
i.e. hypothalamus or pituitary failure
14
Q
Causes of secondary adrenal insufficiency
A
- Chronic steroid use –> supression of HPA axis
- Pituitary apoplexy/Sheehans
- Pituitary microadenoma
15
Q
Features of secondary adrenal insufficiency
A
- Normal mineralcorticoid production
2. No pigmentation (ACTH drop)
