adrenal insufficiency

Question 1

whta

Answer 1

adrenal glands don’t produce enough steroid hormones esp cortisol and aldosterone

Question 2

addison’s disease

Answer 2

adrenal glands have been damaged
1ry adrenal insufficiency
most commonly autoimmune

Question 3

secondary adrenal insufficiency

Answer 3

inadequate ACTH stimulating adrenal glands

surgery to remove pituitary tumour, infection, loss blood flow, radiotherapy

Question 4

tertiary adrenal insufficiency

Answer 4

inadequate CRH release by hypothalamus

usually due to long term steoroid treatment suppressing hypothalamux and sudden withdrawal

Question 5

symptoms

Answer 5

fatigue 
nausea
cramps 
abdo pain 
reduced libido

Question 6

signs

Answer 6

bronze hyperpigmentation

hypotension esp postural

Question 7

Ix

Answer 7

hyponatreamia
hyperkalamia
early morning cortisol
short synacthen test

Question 8

short synacthen test

Answer 8

give synthetic ACTH, blood cortisol baseline measured and then 1hr after administration
cortisol level should at least doyble

Question 9

treatment

Answer 9

replacement steroids

hydrocortisone to replace cortisol
fludrocortisone to replace aldosterone

Question 10

addisonian crisis

Answer 10

acute presentation of severe addisons

absence of steroid hormones leads to life threatening presentation

Question 11

addisonian crisis: presentation

Answer 11

reduced conscioussness
hypotension 
hypoglycemia 
hyponatremia 
hyperkalaemia

Question 12

addisonian crisis triggers

Answer 12

can be 1st presentation of addison’s

infection, trauma

Question 13

addisonian crisis Mx

Answer 13

monitoring electrolytes and fluid balance
parenteral steroids
IV fluid resus
correct hypoglycaemia