Musculoskeletal system Flashcards
Primary adrenal insufficiency (Addison’s disease)
*causes include: autoimmune disease, cancer, infections
*metabolic derangmenets include: hyponatremia, hyperkalemia, hypoglycemia
*presentation: insidious, and non-specific
-nausea, fatigue, weakness
-hypotention
-stress such as trauma or surgery can precipitate an acute adrenal crisis in those with chronic adrenal insufficiency, which presents with vomiting, abdominal pain, and hypovolemic shock
*Dx:
Cosyntropin stimulation test; cortisol levels will be low after stimulation with ACTH
Plasma ACTH is high in primary adrenal insufficiency
*Pathology: depends on the etiology
-size of the adrenals shrinks with autoimmune adrenalitis
-granulomas may be seen with fungal or tuberculous adrenal infections
Ddx:
-septic shock (in which case, cortisol should be high)
*acute adrenal crisis may be present with features of acute abdomen
*Tr:
glucocorticoids and mineralocorticoids, androgen replacement is optional
*primary adrenal insufficiency causes hyperpigmentation due to elevated levels of ACTH
*serum potassium level is maintained in secondary adrenal insufficiency because aldosterone production is maintained (RAA axis)
*the commonest cause of secondary adrenal insufficiency is iatrogenic (external steroid supplementation for other diseases)
