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endocrinology > Addison's disease ↓cortisol ↓aldosterone > Flashcards

Addison's disease ↓cortisol ↓aldosterone Flashcards

1
Q

main cause of primary hypoaldosteronism?

A

Addison’s disease

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2
Q

% of primary hypoaldosteronism caused by addison’s disease?

A

80%

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3
Q

in addison’s disease which two hormones decrease?

A

↓cortisol

↓aldosterone

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4
Q

in addison’s disease which two hormones decrease?

these hormones belong to what sub groups/categories within corticosteroids?

A

↓cortisol-glucocorticoid

↓aldosterone-mineralocorticoid

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5
Q

vitamin CDEF addison’s disease?

A

autoimmune

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6
Q

what happens to adrenal glands in addison’s disease?

A

autoimmune destruction

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7
Q

what happens to negative feedback in addison’s disease?

effect of this on ACTH?

A

no negative feedback

↑ACTH

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8
Q

why is there no no negative feedback in addison’s?

A

↓cortisol

↓aldosterone

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9
Q

effect of ↓aldosterone?

-5

A

hyperkalaemia + hyponatraemia + dehydration + ↓BP + metabolic acidosis

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10
Q

effect of ↓cortisol?

-1 (main one)

A

hypoglycaemia

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11
Q

effect of ↑ACTH? - which hormone increases because of high ACTH?

A

↑MSH

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12
Q

effect of ↑MSH?

-2

A

lose appetite + stimulates melanocytes

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13
Q

symptoms that present with ↑MSH?

-3

A

Anorexia, weight loss &

hyperpigmentation (tanned skin), vitiligo

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14
Q

effect of ↑ACTH on weight?

A

weight loss/anorexic

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15
Q

effect of ↑ACTH on skin?

-2

A

hyperpigmentation (tanned skin), vitiligo

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16
Q

is Addison’s primary or secondary?

A

primary

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17
Q

in Addison’s disease why is low androgens not much of a problem?

A

If adrenal gland destroyed > technically some ↓androgen > but main production of androgen is gonads anyways so has little overall effect)

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18
Q

a pituitary problem (not Addison’s then) would be primary or secondary?

A

secondary

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19
Q

RF for Addison’s?

-2

A

Female

Other autoimmune diseases – T1DM, Hashimoto’s

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20
Q

outline step by step the Morning Cortisol Test?

explain results/ interpret potential results?

A
  1. Cortisol should be high in the morning
  2. Measure morning cortisol
  3. > 500 nmol/L = normal
    <100 nmol = abnormal
    100 – 500 = refer pt to Synacthen test
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21
Q

normal value for Morning Cortisol Test?

A

> 500 nmol/L = normal

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22
Q

abnormal value for Morning Cortisol Test?

A

<100 nmol = abnormal

23
Q

outline step by step the synacthen test?

A
  1. Measure plasma cortisol
  2. Give Synacthen 250ug IM (artificial ACTH)
  3. Measure plasma again after 30 minutes
24
Q

normal and abnormal result for the synacthen test?

A

Normal = ↑cortisol Abnormal – no response

25
Q

cortisol and aldosterone levels in Addisonian crisis?

or just adrenal crisis generally

A

↓↓↓

26
Q

triggers for an Addisonian crisis?

-3

A

sepsis, adrenal haemorrhage, steroid withdrawal

27
Q

main cause of 1° hypoadrenocorticism?

A

addison’s disease

28
Q

which infection can cause 1° hypoadrenocorticism?

A

TB

29
Q

which inflammatory disease results in red swollen patches on skin that can cause 1° hypoadrenocorticism?

A

Sarcoidosis

30
Q

which inherited blood condition can result hypoadrenocorticism?

A

Haemochromatosis

31
Q

other 1° causes of Hypoadrenocorticism:

list all causes of 1° hypoadrenocorticism

A

Systemic amyloidosis

32
Q

2° cause of hypoadrenocorticism is ultimately occurring where?

A

Pituitary gland

33
Q

specifically, what could cause a problem at the pituitary gland?
-2

A

tumour, irradiation

34
Q

2° hypoadrenocorticism will have what ACTH levels?

A

↓ACTH

35
Q

symptoms of Addison’s disease?

-5

A 
Lethargy 
Weakness 
N&V 
salt craving
Women lose pubic hair
36
Q

why is there lethargy and weakness?

A

dehydrated

37
Q

symptoms of Addison’s disease from the ↑MSH?

-3

A

Anorexia
Weight loss
Hyperpigmentation
Vitiligo

38
Q

pt has Addison’s disease.
effect on BP?
-2

why?

A

low BP/postural hypotension

↓Na+

39
Q

why is ↓Na+ in Addison’s disease?

A

↓aldosterone

40
Q

↓aldosterone on ABG?

A

metabolic acidosis

41
Q

↓aldosterone on U+Es?

-2

A

↓Na+

↑K+

42
Q

↓cortisol effect on glucose?

A

↓glucose

43
Q

person has hypoadrenocorticism.

how can ACTH tell you wher cause is?

A

↑ACTH – 1° cause at adrenal gland

↓ACTH – 2° cause at pituitary gland

44
Q

person has suspected hypoadrenocorticism.

1st line test?

abnormal result?

A

Morning cortisol test

<100 is Addison’s

45
Q

person has suspected hypoadrenocorticism.

1st line test done.

what is now the diagnostic test?

A

Synacthen test

46
Q

Synacthen test normal result?

and abnormal result?

A

normal – increased cortisol

Addison’s – no response

47
Q

person has suspected hypoadrenocorticism.

you suspect thyroid cancer.

main Ix to check this?

A

CT thyroid

48
Q

pt has Addison’s disease (1° hypoadrenocorticism).

main drugs to treat the
↓cortisol?
↓aldosterone?

A

Replace cortisol - Hydrocortisone

Replace aldosterone - fludrocortisone

49
Q

pt has Addison’s disease.

what advice do you give,
why?

A

do not miss doses

risk Addisonian crisis

50
Q

pt has Addison’s disease.

you warn of Addisonian crisis.

what do you give pt to take home in case he/she gets Addisonian crisis?

A

give pt hydrocortisone injection to take home

51
Q

Adrenal crisis at Hospital.

what is Mx?
-3 steps

A
  1. Hydrocortisone 100mg IM or IV
  2. 1 litre saline infusion
  3. Put dextrose in above infusion if hypoglycaemic
52
Q

Complications of giving hydrocortisone?

A

overdosing on hydrocortisone > Cushing’s syndrome

53
Q

% wise how many people will get adrenal crisis at some point?

A

40%

54
Q

what is synacthen

A

man made ACTH

endocrinology (16 decks)

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