Addison's disease/ Adrenal insufficiency

Question 1

Adrenal insufficiency

Answer 1

Where the adrenal glands do not produce enough steroid hormones

Cortisol and aldosterone

Question 2

Addison’s disease

Answer 2

Adrenal glands damaged resulting in reduction in secretion of cortisol and aldosterone

Also called primary adrenal insuffieicny

Question 3

Most common cause of Addison’s disease

Answer 3

Autoimmune

Question 4

Secondary adrenal insufficiency

Answer 4

Results of inadequate ACTH stimulating the adrenal glands resulting in low cortisol release

Question 5

Causes of secondary adrenal insufficiency

Answer 5

Surgery to remove a pituitary tumour

Infection

Loss of blood flow

Radiotherapy

Sheehan’s syndrome (pituitary gland necrosis)

Question 6

Tertiary adrenal insufficiency

Answer 6

Result of inadequate CRH release by the hypothalamus

Question 7

Causes of tertiary adrenal insufficiency

Answer 7

Long term oral steroids
- when exogenous steroids are suddenly withdrawn, the hypothalamus doesn’t wake up fast enough and endogenous steroids are not adequately produce

Question 8

Symptoms of adrenal insufficiency

Answer 8

Fatigue

Nausea

Cramps

Abdominal pain

Reduced libido

Question 9

Signs of adrenal insufficiency

Answer 9

Bronze hyperpigmentation to skin (ACTH stimulates melanocytes to produce melanin)

Hypotension

Question 10

Blood test findings

Answer 10

Hyponatraemia

Hyperkalaemia

Question 11

Test of choice for adrenal insufficiency

Answer 11

Short synacthen test (ACTH stimulation test)

Question 12

ACTH test

Answer 12

Plasma cortisol measured before and 30 and 60 minutes after giving synacthen IM

Question 13

Primary adrenal insufficiency short synacthen test findings

Answer 13

Adrenals cant produce cortisol so failure of cortisol to rise indicates Addison’s

Question 14

Treatment of adrenal insuffiency

Answer 14

Hydrocortisone as glucocorticoid to replace cortisol (majority of dose given in the first half of the day)

Fludrocortisone is mineralocorticoid to replace aldosterone if also insufficient

Question 15

Addisonian crisis symptoms

Answer 15

Reduced consciousness

Hypotension

Hypoglycaemia

Hyponatraemia

Hyperkalaemia

Question 16

Management of Addisonian crisis

Answer 16

Intensive monitoring if unwell

Parenteral steroids

IV fluid resuscitation

Correct hypoglycaemia

Careful monitoring of electrolytes and fluid balance

Question 17

Management of adrenal insufficiency when also other acute illness

Answer 17

Glucocorticoid dose should be doubled

Fludrocortisone dose stays the same