Adrenal Insufficiency

Question 1

What is addison’s disease?

Answer 1

This is when the adrenal glands have been damaged, resulting in a reduction in cortisol and aldosterone

Question 2

What is secondary adrenal insufficiency?

Answer 2

Result of central (brain) insufficiency, meaning there is inadequate CRH or ACTH stimulating the adrenals (therefore low cortisol)

Question 3

What are the clinical features of adrenal insufficiency?

Answer 3

fatigue, nausea, bronze hyper pigmentation, cramps, abdo pain, hypotension, reduced libido, hyponatraemia

Question 4

What are signs and symptoms of an addisonian crisis?

Answer 4

reduced consciousness, hypotension, hypoglycaemia. hyponatraemia, hyperkalaemia

Question 5

What is the treatment of an addisonian crisis?

Answer 5

IV hydrocortisone 100mg/6hrs

IV fluid resuscitation – IV saline 2-3L first hour, then 3-4L per day

Question 6

How is addison’s diagnosed?

Answer 6

Short synacthen test - failure of cortisol to rise following ACTH administration.

Question 7

How is adrenal insufficiency managed (6)?

Answer 7

• Replacement steroids – titrated to clinical sign, symptoms and electrolytes
• Hydrocortisone – used to replace cortisol
• Fludrocortisone – replace aldosterone
• Steroid card and emergency ID card
• Doses should not be missed
• Double doses of steroids in illness until recovered