Week 2: Addison's disease Flashcards

1
Q

Etiology of adrenal insufficiency

A
  1. Primary: adrenal gland destruction
    - autoimmune- 70%
    - tuberculosis -20%
    - other - 10%
  2. Secondary: loss of ACTH/CRH
    - exogenous glucocorticoids
    - cure of Cushing’s syndrome
    - hypothalamic/pituitary disease
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2
Q

Actions of glucocorticoids: Type 1 and Type 2 responses

A
  1. Type I GC receptor (aka MC receptor)
    - health/wellbeing. High affinity and low capacity.
    - promotes anabolism, sustains response to catecholamines, maintains lean body mass, preserves normal vascular tone, cognitive function, clearance of free water, reproductive function
  2. Type 2 GC receptor
    - illness/fasting, low affinity, high capacity
    - high energy mobilization: increase blood glucose, promotes muscle catabolism, hepatic glycogenolysis and gluconeogensis
    - increases insulin resistance
    - modulates immune response: prevents overshooting through various mechanisms, e.g. blocking cytokines, block WBC egress from circulation, decrease lymphocytes, increase neutrophils
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3
Q

Clinical features of adrenal insufficiency

A
  1. Chronic
    - weakness, weight loss, fatigue, anorexia, nausea, vague ab pain, diarrhea, orthostatic dizziness, salt craving, depression, decrease in libido
    - hyperpigmentation of skin, scars, areas of repeated trauma, vitiligo, (patients look dirty)
  2. Acute
    - myalgias/arthralgias, severe abdominal pain, nausea, vomiting, postural hypotension,
    - fever, dehydration, marked hypotension, altered sensorium
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4
Q

Laboratory findings in adrenal insufficiency

A
  • hyponatremia
  • metabolic acidosis
  • hypoglycemia
  • anemia: normochromic, normocytic
  • eosinophilia
  • hyperkalemia
  • prerenal azotemia
  • hypercalcemia- rare
  • neutropenia
  • lymphocytosis
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5
Q

Diagnosis of adrenal insufficiency

A
  1. Acute
    - clinical signs and symptoms
    - serum cortisol level9 mg rise is normal. 15 normal
    - cortisol15 normal, <15=AI
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6
Q

Therapy for acute and chronic adrenal insufficiency

A

ACUTE
-IV hydration with normal saline
-IV glucocorticoids
CHRONIC
-glucocorticoid replacement, hydrocortisone 15mg/5mg
-mineralocorticoid replacement, fludrocortisone 0.1mg
-medalert and education: serum K= levels for adequency of fludrocortisone dose, symptoms for adequacy of hydrocortisone dose, double daily hydrocortisone dose with stress

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7
Q

Primary vs secondary adrenal insufficiency: symptoms+labs

A
PRIMARY
-weight loss
-wasting
-hyperpigmentation
-hyper K+
-elevated ACTH w/ low cortisol
-low cortisol with 3 day ACTH stimulation test
SECONDARY
-weight gain
-obesity
-normal pigmentation
-normal K+
-low ACTH+low cortisol
-normal cortisol after ACTH stimulation test for 3 days
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