Addison’s Disesase Flashcards
(30 cards)
How does adrena insufficiency present
Hypotension
Fatigue and weakness
Nausea and vomiting
Syncope
Skin pigmentation due to increased ACTH
What are the diagnostic findings for Addison;s?
U&E and serum cortisol:
Hyperkalemia
Hyponatremia
Low serum cortisol
Low glucose
What are the blood gas findings for Addison’s?
hyperkalaemic, hyponatraemic, hypoglycaemic metabolic acidosis
What is the gold standard to confirm Addison’s disease?
Short synacthen test
What are the symptoms of
What is the management of Addison;s?
Glucocorticoids with hydrocortisone and mineralcorticoids with Fludrocortisone
What should be measured in testing for Addison’s?
Plasma cortisol before and after synacythen test
What is the management of Addisonian crisis?
Aggressive fluid resuscitation
IM steroids of glucocorticoid
Glucose administration if hypoglycaemia is present
What is the initial treatment of Addisonian crisis?
Resuscitation with IV fluids
IM steroids
Glucose if hypoglycaemic
What are the primary causes of hypoadrenalism?
AKA Addision’s caused by:
Tuberculosis
Metastasis from bronchial carcinoma
Meningococcal septicaemia
HIV
Antiphospholipid syndorme
How does TB cause Adison’s?
Spread of bacteria to adrenal glands
How does meningococcal septicaemia cause adrenal insufficiency?
AKA Waterhouse-Friederichsen syndorme where bilateral adrenal haemorrhage occurs due to an infection fromNeisseria menigitidis causing meningococcal septicaemia.
Patients will present with ongoing infection and signs of acute adrenal insufficiency
How does Waterhouse Friedrechson syndrome present?
Meningococcemai causes petechia rash, DIC and purpura on lower trunk and mucous membranes
Symptoms of infection and sepsis
When is hydrocortisone taken?
First half of the day in the morning
What are the sick day rules for Addision’?
Double glucocorticoid dose
Fludrocortisone says the same.
What are the causes of Addisonian crisis?
sepsis or surgery causing an acute exacerbation of chronic insufficiency (e.g. Addison’s, hypopituitarism)
adrenal haemorrhage e.g. Waterhouse-Friderichsen syndrome (fulminant meningococcaemia)
steroid withdrawal (most common precipitant)
inadequate ‘sick day rule’ management or intercurrent illness (commonly gastroenteritis) in patients with underlying Addison’s disease
Which medication is not required in ACUTE Addisonian crisis?
no fludrocortisone is required acutely as high-dose cortisol exerts a weak mineralocorticoid effect
What is Waterhouse-Friderichsen syndrome?
A severe, potentially fatal condition caused by significant bacterial infection leading to disseminated intravascular coagulation and adrenal hemorrhage.
What are the primary consequences of Waterhouse-Friderichsen syndrome?
Rapid onset of adrenal insufficiency and potential catastrophic outcomes.
What is a common bacterial infection associated with Waterhouse-Friderichsen syndrome?
Neisseria meningitidis.
Name another bacterial infection that can trigger Waterhouse-Friderichsen syndrome.
Streptococcus pneumoniae.
What triggers the severe systemic inflammatory response in Waterhouse-Friderichsen syndrome?
Infection by bacteria, leading to disseminated intravascular coagulation.
What are the initial clinical features of Waterhouse-Friderichsen syndrome?
Nonspecific signs of infection such as fever, malaise, and body aches.
