Adrenal

Question 1

acute adrenal crisis

Answer 1

high fever, weakness, apathy, confusion
anorexia, nausea, vomiting, > lead to volume depletion.
abdominal pain, hypoNa, hypoK, lymphocytosis, eosinophilia, hypoglycaemia
precipitants - infection, trauma, surgery, dehydration.

unrecognised and untreated > coma, severe hypotension, shock unresponsive to vasopressors may rapidly lead to death.

Question 2

Labs in primary adrenocortical insufficiency

Answer 2

hyponatremia, hyperkalemia, hypoglycaemia, mild azotemia.

hypoNa & K > MC deficiency
azotemia, with elevated BUN, s creatinine due to > volume depletion and dehydration.
mild acidosis is frequently present
hyperglycaemia mild-mod infrequently

Question 3

secondary adrenocortical insufficiency

Answer 3

MC is usually normal (S Na, K, creat, BUN, HCO3 - normal)
plasma glucose - maybe low

Question 4

haematology manifestation of adrenal insufficiency

Answer 4

normocytic normochromic anaemia, neutropenia, lymphocytosis, monocytosis, eosinophilia.

Question 5

other investigation findings

Answer 5

CT - calcification of adrenals
ECG - low voltage, vertical QRS axis, and non specific ST-T wave changes related to electrolyte abnormalities.

Question 6

investigation for primary adrenal insufficiency

Answer 6

ACTH stimulation test
- 8 am plasma cortisol
- administer cosyntropin (synthetic ACTH 250mcg IV/IM
- plasma cortisol levels at 60 mins, 120 mins

normal: normla 8am level and 2x high following synthetic
Addisons: low 8am level and no increase following synthetic

Question 7

investigation for secondary adrenal insufficiency

Answer 7

obtain history of glucocorticoid therapy or by finding cushingoid features on PE