Adrenal: Adrenal Insufficiency Flashcards
(19 cards)
What is adrenal insufficiency?
Adrenal glands do not produce enough steroid hormones (cortisol and aldosterone)
Adrenal insufficiency may affect overall health and requires treatment.
What hormones are produced by the adrenal glands?
Aldosterone (a mineralocorticoid)
Cortisol (a glucocorticoid)
Androgens and estrogen (sex hormones)
Where are each of the hormones produced by the adrenal gland?
What are the hormones affected by PRIMARY adrenal insufficiency?
- Cortisol
- Aldosterone
- Androgens (female)
Cortisol is associated with stress response, while aldosterone regulates blood pressure and salt/water balance.
What is Primary Adrenal Insufficiency also known as?
Addison’s Disease
This condition results from damage to the adrenal gland.
What are the characteristics of Primary Adrenal Insufficiency?
- All 3 hormones affected
- High ACTH levels
- Caused by autoimmune issues
High ACTH is due to negative feedback from low hormone production.
What characterizes Secondary Adrenal Insufficiency?
- Inadequate ACTH
- Low cortisol only
- Loss/damage to pituitary
Causes include tumors, surgery, and trauma.
What is Tertiary Adrenal Insufficiency?
Inadequate CRH from the hypothalamus
Often caused by long-term steroid use suppressing the hypothalamus.
What must be done when discontinuing long-term steroid use?
Taper slowly to allow the HPA axis to catch up
Abrupt discontinuation can worsen adrenal insufficiency.
List common symptoms of adrenal insufficiency.
- **Fatigue **
- Muscle weakness and cramps
- Dizziness and fainting
- **Thirst and salt craving **
- **Weight loss **
- Abdominal pain
- Depression
- Reduced libido
Symptoms may overlap with other autoimmune conditions.
What is the main sign of Primary Adrenal Insufficiency?
- Bronze hyperpigmentation of skin creases, lips, scars, and mucosa
- Hyponatraemia
- Hyperkalaemia
- HYPOtension
- HYPOglycameia
This occurs due to ACTH stimulating melanocytes.
What are the electrolyte imbalances associated with Primary Adrenal Insufficiency?
- Hyponatraemia (low sodium)
- Hyperkalaemia (high potassium)
- Hypercalcaemia (high calcium)
These imbalances are primarily due to low aldosterone levels.
What is the gold standard test for adrenal insufficiency?
ACTH stimulation test (Short Synacthen test)
This test helps determine the adrenal glands’ response to ACTH.
What are the results of the ACTH analogue test in primary and secodnay adrenal insufficieny
What is the primary treatment for adrenal insufficiency?
Replacement of steroid hormones:
* Cortisol replaced by Hydrocortisone (a glucocorticoid)
* Aldosterone replaced by Fludrocortisone (a mineralcorticoid)
Medications include hydrocortisone for cortisol and fludrocortisone for aldosterone.
What is an adrenal crisis?
Severe adrenal insufficiency
It can be triggered by infections, trauma, or lack of steroid treatment. Or it may be the first presentation of adrenal insufficiency.
What are the sick day rules?
- **SICK DAY RULE: **Double-dose on days that you are unwell, refer to leaflet and GP
What are the signs of an adrenal crisis?
- Reduced consciousness
- Hypotension
- Hypoglycaemia
- Hyponatraemia (Aldosterone - RASS -
- Hyperkalaemia
**WHY: ** Aldoesterone acts on RASS system, wtaer and Na lost causing low BP and hyponatraemia. Cortisol uses up glucose and low aldoesteones does not stimulates kidney to secrete K+ so it is reabsorbed.
These signs indicate a medical emergency requiring immediate intervention.
What is the management protocol for an adrenal crisis?
A-E
* IM or IV hydrocortisone
* IV fluids –> increase the BP
* Correct hypoglycaemia (IV dextrose)
* Monitor electrolytes/fluids
Immediate treatment is crucial to stabilize the patient.
