Oxford Clinical Medicine III Flashcards
What is the condition associated with adrenal insufficiency?
Addison’s Disease
Who are those prone to developing adrenal insufficiency?
- Patients on exogenous steroids long enough to suppress the pituitary-adrenal axis
- Patients with overwhelming sepsis
- Patients who have metastatic cancer
Patient presents with extreme fatigue and for the last 1 month, the most energy requiring activity was to cook herself a pasta meal. There is also a LOW. What is a possible diagnosis?
Addison’s disease.
What are the hormones that are affected in Addison’s disease and how are these hormone levels altered?
Addison’s disease leads to a decrease in the level of glucocorticoid (cortisol) and mineralocorticoid (aldosterone).
Which ion in the bloods can distinguish between Addison’s disease and anorexia nervosa?
In Addison’s disease, there is an increase in K+ ions, but in anorexia nervosa, K+ ion concentration falls.
What is the main cause of Addison’s disease in the UK?
autoimmunity (80% of Addison’s disease)
What is the main cause of Addison’s disease worldwide?
TB
What is the action of Aldosterone?
Aldosterone is a hormone that is released when there is a drop in BP.
The release of aldosterone leads to increased Na+ (and decreased K+) as it increases Na+ reabsorption from the urine, sweat and gut.
What test is done to diagnose Addison’s disease?
What conditions can give a false negative result in this test?
ACTH stimulation test.
Pregnancy and the taking of contraceptive pills can cause a falsely increased cortisol level.
Steroid drugs can also give a false negative result.
What is the treatment of Addison’s disease?
For cortisol: Replacement of steroids by giving 15-25MG of Hydrocortisone given in 2-3 doses over 24 hours.
For mineralocorticoid such as aldosterone: give Mineralocorticoid replacement, such as Fludrocortisone PO from 50-200microgram OD
What is Virilism?
Virilism is the onset of amenorrhoea, clitoromegaly, deep voice, temporal hair recession and hirsutism.
When should borderline hypoglycaemia be investigated?
According to the Whipple’s triad:
- Symptoms of hypoglycaemia
- Decreased plasma glucose
- Resolution of signs and symptoms of hypoglycaemia with glucose intake
What are the signs of renal failure?
Microalbuminuria
Increased Creatinine
Dipstick proteinuria
What is CER10?
CER10 is the 10 year coronary event risk
What are “cotton wool spots”?
Cotton Wool spots are local infarcts of the surface of the retina that occurs due to impairment of blood supply.
They are also known as ‘soft exudates’.
