Hypoaldosteronism Flashcards
Another name to Addison’s disease
Adrenal insufficiency
Pathophysiology in Primary adrenal insufficiency
Damage to adrenal gland -> reduction in cortisol and aldosterone
Pathophysiology of central (secondary) adrenal insufficiency
* secondary = due to problems with the pituitary gland or hypothalamus
Result: inadequate secretion of CRH or ACTH
Can exogenous steroid use result in adrenal insufficiency?
- Yes - it can result in secondary adrenal insufficiency
- If the patient is on long-term steroids -> CRH or ACTH suppression
(due to negative feedback loss)
*even if the steroids are withdrawn patient may still not be able to stimulate their adrenal glands
Features of Adrenal Insufficiency
- Fatigue
- Nausea
- Bronze hyperpigmentation to skin
- Cramps
- Abdominal pain
- Poor weight gain / weight loss
- Developmental delay or poor academic performance
What is Addisonian Crisis?
aka adrenal crisis
- acute presentation of severe Addison
*often the first presentation
Cause of Addisonian crisis (2)
Can be the first presentation
Caused by:
- Sudden withdrawal of long term steroids
- Triggered by infection, trauma or other acute illness in someone with established Addisons
Features of Addisonian Crisis
- Reduced consciousness and hypotension
- Weakness, nausea, vomiting, abdominal pain
- Seizures
- Hypoglycaemia, hyponatraemia, hyperkalaemia
- Patients can be very unwell
Treatment of Addisonian Crisis
- Intensive monitoring of U&Es and glucose
- Parenteral steroids (IV hydrocortisone)
- IV fluid resuscitation
- Correction of hypoglycaemia
- Treat infection is suspected
Blood tests result in Addison’s
Addisons = primary adrenal insufficiency (due to adrenal glands)
Addisons
- Low cortisol
- High ACTH
- Low aldosterone
- High renin
Blood test results due to secondary adrenal insufficiency
Secondary: brain (hypothalamus, pituitary) or long-term steroids
- Low cortisol
- Low ACTH
- Normal aldosterone
- Normal renin
Treatment of Addison’s disease
- Replacement steroids titrated to clinical sign, symptoms and electrolytes
- Hydrocortisone is used to replace cortisol (the glucocorticoid)
- Fludrocortisone is used to replace aldosterone (the mineralocorticoid) where required
- Growth and development should be monitored closely
- Patients are given a steroid card and emergency ID tag to alert emergency services if needed
- Doses should not be missed (they are essential to life)
- Should have an individual care plan for the event of an illness
(2) types of steroids used in Rx of Adrenal Insufficiency
- Hydrocortisone is used to replace cortisol (the glucocorticoid)
- Fludrocortisone is used to replace aldosterone (the mineralocorticoid) where required
*dose cannot be missed = essential to life
Do we increase dose of steroids if a patient has a minor cough/cold (no fever)?
No
(if fever - then we need to)
What type of illness do we need to increase steroids in? (in patient with adrenal insufficiency)
Fever (over 38 C) or / and vomiting, diarrhoea
There is an increased demand for the steroids to deal with an illness -> may develop hypoglycaemia
What does patient with adrenal insufficiency, need to have in case of an illness?
Individual care plan
What is included in the ‘individual care plan’?
Individual care plan - in case of the illness and increased demands for steroids
- increased dose and given more regularly until the illness has completely resolved
- Blood sugar needs to be monitored closely and they need to eat foods containing carbohydrates regularly
- If they have diarrhoea or vomiting, they will need an IM injection of steroid at home and likely required admission for IV steroids
