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Year Two - Endocrine System > Addison's Disease > Flashcards

Addison's Disease Flashcards

1
Q

What is another term for Addison’s disease?

A

Autoimmune adrenalitis

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2
Q

What is Addison’s disease?

A

It is defined as a condition in which there is autoimmune destruction of the adrenal glands, resulting in reduced cortisol and aldosterone secretion

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3
Q

What antibodies are produced in Addison’s disease?

A

Anti-21 hydroxylase autoantibodies

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4
Q

What is the most common cause of adrenal insufficiency?

A

Addison’s disease

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5
Q

What are the nine clincial features of Addison’s disease?

A

Fatigue

Nausea & Vomiting

Muscle Weakness

Hyperpigmentation

Vitiligo

Salt Craving

Weight Loss

Hypotension

Syncope

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6
Q

In most cases where does hyperpigmentation present in Addison’s disease?

A

Palmar Creases

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7
Q

What is vitiligo?

A

It is characterised by pale white patches appearing on the skin

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8
Q

In exams, how does Addison’s disease tend to present?

A

The clinical features can be non-specific, it is important to look at the blood for hyponatraemia and hyperkalaemia

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9
Q

What are the four investigations used to diagnsoe Addison’s disease?

A

Blood Tests

Arterial Blood Gas (ABG)

ACTH Stimulation Test

MRI Scan

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10
Q

What are the seven blood test results indicative of Addison’s disease?

A

Decreased Sodium Levels

Increased Potassium Levels

Increased Calcium Levels

Decreased Glucose Levels

Decreased Cortisol Levels

Increased ACTH Levels

21-Hydroxylase Antibodies

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11
Q

When is serum cortisol conducted to investigate Addison’s disease?

A

It is conducted in primary care, where the ACTH stimulation test is not readily available

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12
Q

When should serum cortisol levels be measured?

A

Morning

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13
Q

What serum cortisol level excludes Addison’s disease?

A

> 500

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14
Q

What serum cortisol level indicates Addison’s disease? What investigation should be conducted to confirm a diagnosis?

A

< 500

ACTH stimulation test

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15
Q

What ABG feature indicates Addison’s disease?

A

Metabolic acidosis

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16
Q

What is another term for the ACTH stimulation test?

A

Short Synacthen test

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17
Q

What is the gold standard investigation of Addison’s disease?

A

ACTH stimulation test

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18
Q

What is the ACTH stimulation test?

A

It involves the patient’s initial cortisol and ACTH levels being measured – ideally in the morning

We then inject the patients with IM tetracostartin, which is synthetic ACTH

Following administration, the cortisol levels are remeasured at 30 and 60 minutes

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19
Q

What is a normal ACTH stimulation test result? Explain this

A

Increased cortisol levels at 30 - 60 minutes - usually to > 450

The synthetic ACTH administration will stimulate production of cortisol levels

20
Q

What ACTH stimulation test result indicates Addison’s disease? Explain this

A

Decreased cortisol levels at 30 and 60 minutes

The synthetic ACTH administration will fail to stimulate the production of cortisol levels

21
Q

How is the ACTH stimulation test used to differentiate between Addison’s disease and other causes of adrenal insufficiency?

A

Plasma ACTH levels

22
Q

What plasma ACTH levels in the ACTH stimulation test indicate Addison’s disease? Explain

A

Increased plasma ACTH levels

This is due to the fact that Addison’s disease is a primary cause of hypoadrenalism, and therefore ACTH levels are elevated to stimulate cortisol production

23
Q

What plasma ACTH level in the ACTH stimualtion test indicates secondary adrenal insufficiency? Explain this

A

Decreased plasma ACTH levels

This is due to the fact that pituatary dysfunction results in inadequate ACTH levels stimualting the adrenal glands

24
Q

How are MRI scans used to investigate Addison’s disease?

A

They are used to exclude other causes of adrenal insufficiency, such as adrenal tumours, haemorrhage or structural pathology

25
Q

What are the two pharmacological management options of Addison’s disease?

A

Hydrocortisone

Fludrocortisone

26
Q

When is hydrocortisone used to manage Addison’s disease?

A

It is the first line management option, alongside fludrocortisone

27
Q

How is hydrocortisone used to manage Addison’s disease?

A

It is used to replace glucocorticoids – cortisol

28
Q

How do we administer hydrocortisone - in terms of dosage?

A

In most cases, individuals require 20 – 30 mg of hydrocortisone daily, which is administered in two divided doses per day - morning and evening

29
Q

What hydrocortisone dose is greater - morning or evening? Why?

A

The morning dose is usually greater than the evening dose

This is to mimic the normal 24 hour fluctuation of cortisol levels

30
Q

What should all Addison’s disease patients be administered to treat adrenal crisis?

A

Hydrocortisone injections with needles and syringes

31
Q

When is fludrocortisone used to manage Addison’s disease?

A

It is the first line management of Addison’s disease, alongside hydrocortisone

32
Q

How is fludrocortisone used to manage Addison’s disease?

A

It is used to replace mineralocorticoids – aldosterone

33
Q

How do we administer fludrocortisone - in terms of dosage?

A

In most cases, individuals require 50 – 300 mg of fludrocortisone daily, which is adjusted according to their clinical status, U&Es and plasma renin level

34
Q

What should all Addison’s disease patients wear at all times? Why?

A

MedicAlert bracelets and steroid cards

This is to allow emergency services to quickly identify their steroid dependency

35
Q

How is pharmacological management adjusted in Addison’s disease when individuals are ill?

A

We advise them that their glucocorticoid dose should be doubled, with the fludrocortisone dose remaining the same

This is to match the normal steroid response

36
Q

How is pharmacological management adjusted in Addison’s disease when individuals are ill - with vomiting?

A

They should administer IM corticosteroids until the vomiting stops

37
Q

What is a complication of Addison’s disease?

A

Addisonian Crisis

38
Q

What is addisonian crisis?

A

It is defined as a life threatening deterioration of Addison’s disease, in which there is significantly reduced steroid levels

39
Q

What are the four causes of addisonian crisis?

A

Sepsis

Surgery

Adrenal Haemorrhage (Waterhouse-Friderichsen Syndrome)

Steroid Withdrawal

40
Q

What are the four clinical features associated with Addisonian crisis?

A

Confusion

Severe Weakness

Delirium

Hypotension

41
Q

What are the three management options of addisonian crisis?

A

IM/IV 100mg Hydrocortisone 6 Hrly Until Stable

IL Normal Saline Infused 30 – 60 Minutes

Dextrose Infusion If Hypoglycaemia

42
Q

What is primary adrenal insufficiency?

A

It is defined as adrenal gland dysfunction leading to direct reduced cortisol and aldosterone levels

43
Q

What are the eight other causes of primary adrenal insufficiency?

A

Tuberculosis

HIV

Meningococcal Sepicaemia

Renal Cancer

Lung Cancer

Breast Cancer

Antiphospholipid Syndrome

Postadrenalectomy

44
Q

What is another term for meningococcal septicaemia?

A

Waterhouse-Friderichsen syndrome

45
Q

What is secondary adrenal insufficiency?

A

It is a result of pituatary gland dysfunction resulting in inadequate ACTH stimulating the adrenal glands

This results in reduced cortisol levels ONLY

46
Q

What are the three causes of secondary adrenal insufficiency?

A

Pituatary Adenoma

Sheehan’s Syndrome

Steroids

47
Q

What clincial feature differentiates between primary and secondary adrenal insufficiency?

A

Hyperpigmentation

It is only present in primary adrenal insufficiency

Year Two - Endocrine System (17 decks)

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