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Flashcards in Addison's disease Deck (19)
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1
Q

What is it?

A

destruction of the entire adrenal cortex -> mineralocorticoid, glucocorticoid and sex deficiency

2
Q

What is the most common cause of primary hypoadrenalism

A

autoimmune - abs directed against adrenal cortex and/or 21-hydroxylase

3
Q

Explain the hypothalamic pituitary adrenal axis

A

Hypothalamus releases corticotrophic releasing hormone (CRH)
Anterior pituitary releases adrenocorticotrophic hormone (ACTH)
Adrenals release cortisol which has -ve feedback effect on hypothalamus and ant. pituitary

4
Q

What are the symptoms of primary adrenal insufficiency?

A
  1. Lethargy, depression, low mood
  2. Anorexia + WL
  3. GI: N+V, diarrhoea, constipation, abdo pain
  4. Skin pigmentation - esp. palmar creases, vitiligo
  5. Postural hypotension
5
Q

When should you always consider Addisons?

A

unexplained abdo pain or vomiting

6
Q

What tests would you do?

A
  1. Hyponatraemia + hyperkalaemia
  2. Hypoglycaemia (low cortisol)
  3. Uraemia
  4. Raised Ca2+
  5. Eosinophilia (cortisol has anti-inflammatory effects)
  6. CXR if TB hx
7
Q

What test is diagnostic for Addisons?

A

Short ACTH stimulation test:
measure plasma cortisol before and 30 mins after IM TETRACOSACTIDE (SynACTHen - ACTH analogue)
Addisons is excluded if 30min cortisol >550nmol/L

8
Q

What is the treatment if primary adrenal insufficiency ?

A

Replace steroids 3x daily to mimic circadian rhythm:
- glucocorticoids - oral hydrocortisone/prednisolone
- mineralocorticoids - oral fludrocortisone
Give a steroid drug card and bracelet

9
Q

What should you warn patients against when on treatment?

A

do not abruptly STOP steroids

10
Q

When should the treatment dose be doubled?

A

infection/trauma/surgery/nightshift work

11
Q

When should treatment dose be increased?

A

pregnancy and before strenuous activity/exercise

12
Q

What is secondary adrenal insufficiency?

A

iatrogenic - long term steroid therapy leading to suppression of the pituitary adrenal axis

13
Q

How does secondary adrenal insufficiency present?

A

vague sx of feeling unwell
no skin hyper pigmentation as ACTH is reduced
sx becomes apparent once steroids are stopped

14
Q

How would u differentiate between primary and secondary adrenal insufficiency?

A

Secondary - ACTH levels are low and mineralocorticoid production is intact

15
Q

What is the treatment of secondary adrenal insufficiency?

A

adrenals recover if log term steroids are slowly weaned off - long + difficult
Oral hydrocortisone

16
Q

What are causes of addisonian crisis?

A

infection, trauma, surgery, missed meds

cause acute exacerbation of chronic insufficiency

17
Q

How can a pt in addisonian crisis present?

A

Shock in pt w known Addison’s (tachycardia, postural hypotension, confusion, oliguria etc.)

18
Q

What is the management of an Addisonian crisis?

A
  1. IV HYDROCORTISONE 100mg stat
  2. IV fluid bolus
  3. Bloods for cortisol + ACTH (rx before results if suspected)
  4. K+ can be raised - calcium gluconate
  5. Na can be low - rehydrate + steroids
  6. Monitor glucose
  7. Rx for poss infection i.e. cultures, abx
19
Q

What is the continuing treatment for Addisonian crisis?

A
Glucose IV if hypoglycaemic
IV fluids to correct U&E imbalances 
Continue hydrocortisone IV or IM
Change to oral steroids after 72hrs if pt gd. 
Consider fludrocortisone