clinical aspects adrenal gland Flashcards
primary adrenal insufficiency causes
addison’s disease
adrenal enzyme defects
Addison’s disease
autoimmine - adrenal autoantibodies
lymphocytic infiltrate of adrenal causes
which diseases are assoc w addison’s
autoimmine
thyroid
T1DM
premature ovarian failure
clinical features of 1ry adrenal failure
weakness, fatigue anorexia, weight loss skin pigmentation hypotension vomit/diarrhoea salt craving postural symptoms hypoglc
diagnosis adrenal insufficiency
routine bloods
early morning cortisol (>450 then not addison’s)
synacthen test
glucocorticoid replacement
hydrocortisone 20-30mg
prednisolone 7.5mg
dexamethasone0.75mg
mineralocorticoid replaecment
syntehtic steroid - fludrocortione
rules for patients on steroids
never miss dose
double hydrocortisone if intercurrent illness
if severe vomit/diarrhoea call for help without delay
cushing’s syndrome
excess corticosteroids
effects of excess cortisol
tissue breakdown - weak muscle, bone, skin
sodium retention - htn, heart failure
insulin antagonism- diabetes
clinical features cushings syndrome
moon face neck/back lump cardiac failure diabetes oedema bruising thin hands + feet muscle atrophy replaced by fat moon face
screening for cushing’s syndrome
24hr urinary free cortisol - normal 14-135
1mg overnight dexamethasone suppression test - normal <50
confirmation of hypercortisolism
24hr urine free cortisol
low dose dex test
ACTH dependent hypercortisolism or not?
paired morning - midnight ACTH cortiso
ACTH dependent hypercortisolism
Cushing’s
ectopic ACTH secretin
