31. Hypocortisim Flashcards
(10 cards)
What is hypocortisim?
Hypocortisim is a condition characterized by insufficient cortisol production in the body.
What are the causes of primary adrenal insufficiency?
- Idiopathic (autoimmune, most common)
- Infectious diseases (e.g., TB, fungal infections)
- Iatrogenic causes (e.g., bilateral adrenalectomy)
- Metastatic disease (often from lung or breast cancer)
What is the primary cause of secondary adrenal insufficiency?
Long-term steroid therapy is the primary cause of secondary adrenal insufficiency today.
What is tertiary adrenal insufficiency associated with?
Tertiary adrenal insufficiency is associated with hypothalamic disease.
What are the clinical symptoms of lack of cortisol?
Symptoms include anorexia, nausea, vomiting, abdominal pain, weight loss, lethargy, confusion, psychosis, hypoglycemia, hyperpigmentation, and intolerance to physiologic stress.
What low aldosterone symptoms are seen in primary adrenal insufficiency?
Low aldosterone causes sodium loss leading to hyponatremia and hypovolemia, resulting in weakness, shock, and low blood pressure. It also leads to hyperkalemia due to potassium retention.
What are the diagnostic criteria for hypocortisim?
- Decreased plasma cortisol levels
- Plasma adrenocorticotropic hormone levels (low indicates secondary adrenal insufficiency)
- Standard ACTH test (cortisol levels should exceed 18 μg/dL after ACTH injection)
- MRI of brain (pituitary/hypothalamus)
What is the treatment for primary adrenal insufficiency?
Hydrocortisone 15–25 mg/d divided into 2/3 in the morning and 1/3 in the afternoon, along with daily fludrocortisone (0.05–0.1 mg).
What is the treatment for secondary adrenal insufficiency?
Same as in primary adrenal insufficiency, except mineralocorticoid is not needed.
What should be done during periods of intercurrent illness for hypocortisim patients?
The dose of hydrocortisone should be doubled.
