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Flashcards in Addisons disease Deck (13):
1

what does destruction of the adrenal cortex lead to

glucocorticoid and mineralocorticoid deficiency

2

what is an example of a glucocorticoid

cortisol

3

example of mineralocorticoid

aldosterone

4

causes

80% autoimmunity, TB, adrenal metastases, lymphoma, HIV, congenital

5

symptoms

lean, tanned, tired, weak, anorexia, dizzy, faints,. depression, psychosis, nausea, vomiting, abo pain, diarrhoea, constipation

6

what test can be done

synacthen test- plasma cortisol before and half an hourafter tetracosactide. exclude if cortisol >550nmol/l. (short ACTH stimulating test); 9am ACTH is inappropriately high; 21-hydroxylase adrenal autoantibodies (positive in auto immune); plasma renin and aldosterone

7

what happens to Na, K and glucose, why

Na down, K up due to decreased mineralocorticoid. glucose decr due to decreased cortisol

8

treatment

replace steroids- hydrocortisone, fludrocortisone

9

what is the commonest cause of secondary adrenal insufficiency

iatrogenic- long term steroid use. other causes rare- hypothalamic disease leading to decreased ACTH production.

10

what are the signs and symptoms of an Addisonian crisis

in shock- incr pulse, vasoconstriction, postural hypotension, oliguria, weak, confused, comatose

11

precipitating factors crisis

infection, trauma, surgery, missed medication

12

management crisis

bloods for cortisol and ACTH. U & E. if high K+ give calcium gluconate, if low Na+ resolve with rehydration and steroids. hydrocortisone 100mg IV. IV fluid blous crystalloid or colloid. BM- danger is hypoglycaemia. blood, urine, sputum for culture

13

continuining treatment in crisis

glucose IV if hypo, IV fluids and correct U & E imbalance, continue hydrocortisone 100mg/8h, change to oral steroids after 72h if condition ok. fludrocortisone needed if cause is adrenal disease.