Primary Adrenocortical Insufficiency Flashcards
Where is Corticotropic Releasing Hormone (CRH) is excreted from?
Hypothalamus
What does corticotropic releasing hormone do?
stimulates release of adrenocorticotropic hormone from the anterior pituitary
What does ACTH do?
stimulates the release of aldosterone, cortisol and androgens
What hormones are released by the adrenal cortex?
- mineralcorticoids (aldosterone)
- glucocorticoids (cortisol)
- androgen
What does aldosterone do?
increases sodium and water retention to increase BP
What do glucocorticoids do?
- immunosuppression (inc infections)
- anti-inflammatory effects
- weight gain
- insulin resistance
- skin thinning
- increases osteoclastic activity
- increases BP
Primary adrenocortical insufficiency is also known as what?
Addison’s Disease
Addison’s disease is characterized by deficiency of what?
- cortisol
- androgens
- aldosterone
What are risk factors for the development of Addison’s disease?
- females
- sudden withdrawal of glucocorticoids
- stress
- trauma
- destruction or removal of the adrenal cortex
- sepsis
- tuberculosis
What are the causes of Addison’s disease?
- autoimmune disease
- bilateral adrenal hemorrhage
- metastatic cancer
- infections of the adrenal glands (TB, Immunocompromised)
- genetic predisposition
- decreased levels of ACTH
- drugs
What drugs can cause Addison’s disease?
- Mitotane
- Abiraterone Acetate
- etomidate
- Ketoconazole and fluconazole
- Ipilimumab
What are chronic subjective/physical findings from Addison’s disease?
- Weakness/fatigue
- headache
- N/V
- ABD pain w/ diarrhea
- hyperpigmentation
- little to no axillary hair
- muscle and joint pain
- hypotension
- arthralgias
- weight loss
Hyperpigmentation in Addison’s disease is relate to what?
excess ACTH
What are acute subjective/physical findings have a patient in adrenal crisis?
- Shock or hypotension
- Marked, rapid worsening of chronic symptoms
- fever
- hypovolemia
- changes in LOC
- N/V
- weakness, lethargy
- abd, flank, back or chest pain
9) What laboratory findings are present with primary adrenocortical insufficiency?
- hyponatremia
- hypoglycemia
- hyperkalemia
- elevated erythrocyte sedimentation rate
- neutropenia
- lymphocytosis
- eosinophil count >300/mcl
- plasma cortisol < 3 mcg/dlat 8:00 AM is diagnostic
- hypercalcemia
- elevated BUN
- metabolic acidosis
- serum DHEA levels < 1000ng/mL
What diagnostic testing should be done to diagnose primary adrenal cortical insufficiency?
- CMP
- serum ACTH (high)
- Cosyntropin stimulation test
- serum DHEA level
- chest and abd X Rays
- CT of adrenal glands
A patient with primary adrenal cortical insufficiency will have what results from the cosyntropin stimulation test?
there will be no rise in serum ACTH levels
Elevated morning ACTH levels are indicative of which type of adrenal insufficiency?
Primary adrenal insufficiency
Low levels of morning ACTH are indicative of what type of adrenal insufficiency?
Secondary adrenal insufficiency
What drug is used in the treatment of Addison’s disease?
Hydrocortisone
What should be done if adrenal cortical insufficiency is suspected?
collect cortisol levels
Calcified adrenal gland seen on a CT are commonly seen in what condition?
Tuberculosis causes of adrenal cortical insufficiency
Enlarged adrenal glands seen on a CT may be related to what conditions?
Metastatic or granulomatosis disease
Small, noncalcified adrenal glands seen on a CT is indicative of what?
Autoimmune adrenal disease
If a patient is receiving glucocorticoid treatment, what must be done prior to administering the cosyntropin stimulation test?
Discontinue hydrocortisone at least 8 hours prior to test
