Hypoadrenalism / Addison’s

Question 1

Types?

Answer 1

Primary (addison’s)

Secondary

Question 2

Layers of the adreal cortex and its functions?

Answer 2

Osmosis
Zona glomarulosa - aldosterone
Zona fasciculata - cortisol
Zona reticularis - androgens (testosterone)

Question 3

Causes of primary adrenal insufficiency?

Answer 3

Autoimmune 
Tb 
Hemorrhage/ infarction (meningococcal septicemia, waterhouse friedrichson xd)
Infiltration ( ca,amyloidosis)
Adrenal leucodystrophy

Question 4

Clinical features of primary hypo aldosteronism?

Answer 4

Aldosterone- (^K,^H,reduce Na, hypovolemia)
Craving for salty food 
Dehydration and hypotension 
N V 
Fatigue
Dizziness 
Low anorexia
Postural dizziness 

Cortisol (reduce blood glucose in stress, ^ melanocyte stimulating hormone, ^ ACTH)

• weak,tired ,disoriented
• hyperpigmentation

Testosterone (mainly in femals)

• loss of body hair
• reduce sex drive

Diarrhea ,constipation,vitiligo

Question 5

Ix for primary hyper aldosteronism?

Answer 5

Non specific -
Hyperkalemia 
Hypercalcemia
Hypoglycemia
Hyponatremia

Specific- 
Short synacthen (synthetic acth) test - differentiate primary from secondary 
9 am ACTH Level 
Random cortisol
Long ACTH stimulation test

Question 6

Mx of addisons?

Answer 6

Life long steroid replacement
Glucocorticoids- hydrocortisone 10-5-5mg/ 2/3 in the morning 1/3 in the night
Mineralocorticoid- fludrocortisome 50-300 microg/day
Sick day rules amd during stress. Eed to incraese

Question 7

Causes of secondary hypoaldosteronism?

Answer 7

Exogenous glucocorticoids
Pitutary surgery
Pitutary irradiation
Tumors
Pitutary infarction

Question 8

Adisonian crisis?

Answer 8

Features- 5
Ppt factors- 6
Diagnosis- highe index of suspicion 
Supportive features 
If not very ill- short synacthen test
If very ill- random cortisol and mx as addisons

Tx-
Saline
Iv HC 100mg stat and IM 6 hourly until oral intake is possible
Oral HC 20mg 8 hourly and teduce gradually to maintainance dose
Correct hypoglycemia
Tx underlying ppt condition