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Endocrinology > Addison's disease ↓cortisol ↓aldosterone > Flashcards

Addison's disease ↓cortisol ↓aldosterone Flashcards

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1
Q

main cause of primary hypoaldosteronism?

A

Addison’s disease

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2
Q

% of primary hypoaldosteronism caused by addison’s disease?

A

80%

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3
Q

in addison’s disease which two hormones decrease?

A

↓cortisol

↓aldosterone

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4
Q

in addison’s disease which two hormones decrease?

these hormones belong to what sub groups/categories within corticosteroids?

A

↓cortisol-glucocorticoid

↓aldosterone-mineralocorticoid

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5
Q

vitamin CDEF addison’s disease?

A

autoimmune

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6
Q

what happens to adrenal glands in addison’s disease?

A

autoimmune destruction

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7
Q

what happens to negative feedback in addison’s disease?

effect of this on ACTH?

A

no negative feedback

↑ACTH

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8
Q

why is there no no negative feedback in addison’s?

A

↓cortisol

↓aldosterone

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9
Q

effect of ↓aldosterone?

-5

A

hyperkalaemia + hyponatraemia + dehydration + ↓BP + metabolic acidosis

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10
Q

effect of ↓cortisol?

-1 (main one)

A

hypoglycaemia

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11
Q

effect of ↑ACTH? - which hormone increases because of high ACTH?

A

↑MSH

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12
Q

effect of ↑MSH?

-2

A

lose appetite + stimulates melanocytes

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13
Q

symptoms that present with ↑MSH?

-3

A

Anorexia, weight loss &

hyperpigmentation (tanned skin), vitiligo

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14
Q

effect of ↑ACTH on weight?

A

weight loss/anorexic

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15
Q

effect of ↑ACTH on skin?

-2

A

hyperpigmentation (tanned skin), vitiligo

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16
Q

is Addison’s primary or secondary?

A

primary

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17
Q

in Addison’s disease why is low androgens not much of a problem?

A

If adrenal gland destroyed > technically some ↓androgen > but main production of androgen is gonads anyways so has little overall effect)

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18
Q

a pituitary problem (not Addison’s then) would be primary or secondary?

A

secondary

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19
Q

RF for Addison’s?

-2

A

Female

Other autoimmune diseases – T1DM, Hashimoto’s

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20
Q

outline step by step the Morning Cortisol Test?

explain results/ interpret potential results?

A
  1. Cortisol should be high in the morning
  2. Measure morning cortisol
  3. > 500 nmol/L = normal
    <100 nmol = abnormal
    100 – 500 = refer pt to Synacthen test
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21
Q

normal value for Morning Cortisol Test?

A

> 500 nmol/L = normal

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22
Q

abnormal value for Morning Cortisol Test?

Study These Flashcards
A

<100 nmol = abnormal

23
Q

outline step by step the synacthen test?

Study These Flashcards
A
  1. Measure plasma cortisol
  2. Give Synacthen 250ug IM (artificial ACTH)
  3. Measure plasma again after 30 minutes
24
Q

normal and abnormal result for the synacthen test?

Study These Flashcards
A

Normal = ↑cortisol Abnormal – no response

25
cortisol and aldosterone levels in Addisonian crisis? | or just adrenal crisis generally
↓↓↓
26
triggers for an Addisonian crisis? | -3
sepsis, adrenal haemorrhage, steroid withdrawal
27
main cause of 1° hypoadrenocorticism?
addison’s disease
28
which infection can cause 1° hypoadrenocorticism?
TB
29
which inflammatory disease results in red swollen patches on skin that can cause 1° hypoadrenocorticism?
Sarcoidosis
30
which inherited blood condition can result hypoadrenocorticism?
Haemochromatosis
31
other 1° causes of Hypoadrenocorticism: list all causes of 1° hypoadrenocorticism
Systemic amyloidosis
32
2° cause of hypoadrenocorticism is ultimately occurring where?
Pituitary gland
33
specifically, what could cause a problem at the pituitary gland? -2
tumour, irradiation
34
2° hypoadrenocorticism will have what ACTH levels?
↓ACTH
35
symptoms of Addison's disease? | -5
``` Lethargy Weakness N&V salt craving Women lose pubic hair ```
36
why is there lethargy and weakness?
dehydrated
37
symptoms of Addison's disease from the ↑MSH? | -3
Anorexia Weight loss Hyperpigmentation Vitiligo
38
pt has Addison's disease. effect on BP? -2 why?
low BP/postural hypotension ↓Na+
39
why is ↓Na+ in Addison's disease?
↓aldosterone
40
↓aldosterone on ABG?
metabolic acidosis
41
↓aldosterone on U+Es? | -2
↓Na+ | ↑K+
42
↓cortisol effect on glucose?
↓glucose
43
person has hypoadrenocorticism. how can ACTH tell you wher cause is?
↑ACTH – 1° cause at adrenal gland | ↓ACTH – 2° cause at pituitary gland
44
person has suspected hypoadrenocorticism. 1st line test? abnormal result?
Morning cortisol test <100 is Addison’s
45
person has suspected hypoadrenocorticism. 1st line test done. what is now the diagnostic test?
Synacthen test
46
Synacthen test normal result? and abnormal result?
normal – increased cortisol | Addison’s – no response
47
person has suspected hypoadrenocorticism. you suspect thyroid cancer. main Ix to check this?
CT thyroid
48
pt has Addison's disease (1° hypoadrenocorticism). main drugs to treat the ↓cortisol? ↓aldosterone?
Replace cortisol - Hydrocortisone | Replace aldosterone - fludrocortisone
49
pt has Addison's disease. what advice do you give, why?
do not miss doses risk Addisonian crisis
50
pt has Addison's disease. you warn of Addisonian crisis. what do you give pt to take home in case he/she gets Addisonian crisis?
give pt hydrocortisone injection to take home
51
Adrenal crisis at Hospital. what is Mx? -3 steps
1. Hydrocortisone 100mg IM or IV 2. 1 litre saline infusion 3. Put dextrose in above infusion if hypoglycaemic
52
Complications of giving hydrocortisone?
overdosing on hydrocortisone > Cushing’s syndrome
53
% wise how many people will get adrenal crisis at some point?
40%
54
what is synacthen
man made ACTH

Endocrinology (16 decks)

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