2: Adrenal Insufficiency Flashcards
(39 cards)
What is adrenal insufficiency
Failure adrenal medulla to produce sufficient glucocorticoid and mineralocorticoid hormone
What is primary adrenal insufficiency called
Addison’s disease
What is the most common cause of primary adrenal insufficiency in the UK
Autoimmune (Addison’s)
what is the most common cause of primary adrenal insufficiency worldwide
TB
what are 3 other causes of adrenal insufficiency
- Adrenal metastases (Breast, Lung, Renal)
- Lymphoma
- HIV: mycobacterium avium
- Waterhouse-Freidrichson
- Antiphospholipid syndrome
what cancers may metastasise to the adrenal glands
Liver
Lung
Breast
Lymphoma
when does waterhouse-freidrichson typically occur
Post TB
what are secondary adrenal insufficiency disorders
Iatrogenic - long-term steroid-use which suppress the HPA axis
how can primary and secondary adrenal insufficiency be identified clinically
Primary will cause hyperpigmentation of the skin. This is due to increase in ACTH to try and increase adrenal hormone secretion, with excess being converted to melanin.
what is the problem with diagnosing addisons disease
Non-specific symptoms often leads to a late diagnosis
what are general symptoms of Addison’s disease
- Weak
- Lethargy
- Fatigue
- Anorexia
- Postural hypotension
- Flu-like
what are mood symptoms of addison’s disease
Tearful
Psychosis
Depression
what are GI symptoms of Addison’s disease
Abdominal pain and vomiting
what are skin symptoms of Addisons disease
Hyperpigmentation (primary)
Vitiligo
what investigations are ordered in adrenal insufficiency
- Capillary Blood Glucose
- U+E
- Synacthen test
how will capillary blood glucose present
Low: due to cortisol deficiency
how will U+E present and why
Hyponatraemia, Hyperkalaemia.
Aldosterone usually causes re-absorption of sodium for potassium. Therefore deficiency will result in sodium excretion.
what is the diagnostic test for adrenal insufficiency
Synacthen test (Short ACTH stimulation test)
explain synacthen test
Give IM synacthen and 30m later measure cortisol
what result in synacthen test confirms Addison’s disease
A rise in cortisol >550, excludes Addison’s disease
when may synacthen test not be reliable and why
Pregnancy and COCP - due to increased concentration of cortisol binding globulin which gives falsely high cortisol levels
what antibodies are present in 80% of Addison’s
21-OH adrenal autoantibodies (80%)
when is a AXR and CXR important in primary adrenal insufficiency
Check for fibrosis due to TB
what is given in adrenal insufficiency
- Hydrocortisone
- Fludrocortisone
