Adrenal insufficiency Flashcards
define adrenal insufficiency?
deficiency of adrenal cortical hormones (e.g. mineralocorticoids, glucocorticoids and androgens)
what is the most common cause of Addison’s disease?
autoimmune cause
what is primary adrenal Insufficiency ?
this is when the adrenals are not functioning.
ACTH is still being produced
what is secondary adrenal Insufficiency ?
this is when there is a depletion of ACTH
the adrenals work normally
what is the main iatrogenic cause of adrenal Insufficiency ?
Sudden cessation of long-term steroid therapy
what are the chronic features of addisons?
o Lethargy o Anorexia and weight loss o Nausea and vomiting o Salt craving o Hypotension o Hyperglycaemia o Hyponatraemia and hyperkalaemia
often very vague
what are the acute presentations of addisons?
o Shock
o Pyrexia
o Major haemodynamic collapse
o Precipitated by stress (e.g. infection, surgery)
what is the sign of adrenal insufficiency on examination ONLY in primary causes/
increased pigmentation
what are the general signs of adrenal insufficiency on examination
- Postural hypotension
- Increased pigmentation
- Loss of pubic hair in women
- Associated autoimmune condition
what are signs of addison ian crisis?
o Hypotensive shock o Tachycardia o Pale o Cold o Clammy o Oliguria
what is the first line investigation for adrenal insufficiency?
9am serum cortisol
• > 550 nmol/L makes adrenal insufficiency unlikely
• <100nmol/L is very abnormal
what is the gold standard investigation for addisons?
- IM 250 ug tetrocosactrin (synthetic ACTH)
* Serum cortisol < 550 nmol/L at 30 mins indicates adrenal failure
how to identify the cause of the addisons?
o Autoantibodies (against 21-hydroxylase) - autoimmune cause
what investigations should be done in an addisons crisis?
o FBC (neutrophilia –> infection)
o U&Es
• High urea
• Low sodium
• High potassium
o CRP/ESR o Calcium (may be raised) o Glucose - low o Blood cultures o Urinalysis o Culture and sensitivity o Check TFTs
how to manage an addison ian crisis?
o Rapid IV fluid rehydration
o 50 mL of 50% dextrose to correct hypoglycaemia
o IV 200 mg hydrocortisone bolus
o Followed by 100 mg 6 hourly hydrocortisone until BP is stable
o Treat precipitating cause (e.g. antibiotics for infection)
o Monitor
