Hypoadrenocorticism

Question 1

Hx/clinical signs associated with hypoadrenocorticism

Answer 1

acute or gradual onset
waxing waning
collapse and shock
bradycardia
vomitting and diarrhea
melena
hematochezia
megaesophagus
pu/pd
lethargy
weight loss

Question 2

laboratory abnormalities associated with addisons

Answer 2

• lack of stress leukogram
• azotemia
• hyperkalemia
• hyponatremia
• hypoglycemia
• anemia of chronic dz (mild, non-regen, normocytic, normochromic)

Question 3

typical v atypical addisons

Answer 3

typical: deficient in glucocorticoids and mineralcorticoids, likely to present in crisis with electrolyte abnormalities

atypical: only glucocorticoid deficient, electrolytes OK, do not present in crisis

Question 4

screening test for addisons

Answer 4

baseline cortisol: if the patient has a normal cortisol level, addisons may be be ruled out but a low cortisol level does not confirm addisons

Question 5

what is the confirmatory test for addisons

Answer 5

ACTH Stim: low baseline and post-ACTH cortisol levels indicate addisons disease

Question 6

treating stable addisons patients

Answer 6

• glucocorticoid replacement: prednisone (always), wean to lowest daily dose possible

-mineralcorticoid replacement (typical)

Question 7

how would you treat and unstable (crisis) addisons patient?

Answer 7

1. correct the hyperkalemia (most life threatening issue): fluids, insulin
2. correct hypotension and hypovolemia (fluids)
3. provide glucocorticoids (dexmathasone is the best and will not interfere with ACTH)
4. correct acidosis if possible