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Flashcards in Adrenal Insufficiency Deck (15):
0

symptoms and labs of adrenal insufficiency? Most common cause? Next step?

Sx: Orthostatic hypotension, abdominal pain, constitutional symptoms

Labs: Hyponatremia, hyperkalemia, acidosis, hypoglycemia

Idiopathic autoimmune destruction

Draw cortisol level, give saline with glucose and stress doses of corticosteroids

1

Other causes of primary renal insufficiency?

1. Chronic granulomatous infections (histoplasmosis, Coccidioides)
2. Adrenal hemorrhage
3. Adrenal metastasis (lung, breast, Stomach cancer)
4. X-linked adrenoleukodystrophy

2

Patients with AIDS develop adrenal involvement as a result of these infections?

CMV, MAI

3

In primary renal insufficiency, patient deficient in?

Cortisol and aldosterone

4

secondary adrenal insufficiency? Most common cause?

Lack of ACTH. Exogenous corticosteroids

5

Symptoms of acute renal insufficiency?

Weakness, nausea/vomiting, fever, hypotension, tachycardia

6

Laboratory findings in acute adrenal sufficiency?

Hyponatremia, hypoglycemia,

hyperkalemia, metabolic acidosis,

eosinophilia, azotemia

7

Septic shock versus acute adrenal insufficiency?

Hyperglycemia versus hypoglycemia

8

Effect of pressers on acute adrenal insufficiency? Best tx?

Refractory to pressors. Will reverse which steroids

9

Difference in signs of primary versus secondary adrenal insufficiency?

Secondary: no hyperkalemia or volume depletion (RAAS still makes ALDO) or hyperpigmentation (no ACTH)

10

Diagnosing Adrenal insufficiency?

1. Morning plasma cortisol level <5
2. 7+ increase in cortisol level (Or max level of 18 ug) after 250 ug ACTH

11

Gold standard for testing entire HPA axis?

Insulin-glucose tolerance test

12

Treatment of acute renal insufficiency?

D5, with NS and steroids (hydrocortisone 100 mg every six – eight hours)

13

Why use hydrocortisone?

Provides both glucocorticoid and mineralocorticoid activity

14

Long-term treatment for patients with primary adrenal insufficiency?

Hydrocortisone 25 to 30 mg
Fludrocortisone .1-.2 mg

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