Adrenal Insufficiency Flashcards
causes of primary adrenal insufficiency?
Infection (TB)
Adrenal mets (lung, breast, liver, lymphoma)
Autoimmune - Addisons (most common cause)
definition of adrenal insufficiency?
any condition associated with a reduction of steroids, namely cortisol and aldosterone, due to failure within the adrenal glands
why do you get skin pigmentation?
negative feedback of cortisol production, reduced levels are associated with a rise in ACTH, which is responsible for increased skin pigmentation
how does primary adrenal sufficiency present?
• MSK: myalgia, arthralgia.
• Neurological: dizziness, weakness.
• Psychatric: depression, psychosis.
• GI: abdominal pain, diarrhoea, vomiting.
• General: tiredness, lethargy, weight loss.
• Dermatological: hyperpigmentation of skin, especially of palmar creases.
• Signs
o Vitiligo.
o Postural hypotension.
why would you get postural hypotension in adrenal insufficiency
cortisol and aldosterone cause increase in blood pressure
end up with low blood pressure
why would patient be fatigued?
low cortisol = low glucose
sodium levels, glucose and potassium?
potassium high, glucose and sodium low
what is the test used ?
short synacthen test. giving synthetic ACTH which should cause an increase in cortisol
Measure cortisol before then 30/60 minutes after giving
what would you expect in addisons disease after short synacthen test?
no significant rise in cortisol levels
what do you replace aldosterone with ?
fludrocortisone (aldo fludro)
what do you replace cortisol with?
hydrocortisone
why is cortisol given as divided dose?
to avoid insomnia
on sick days, wha should happen to steroid dose
if unwell, trauma or surgery undertaken –> double steroid dose
causes of addisonian crisis?
bilateral adrenal haemorrhage
suddenly stopping long term steroids
illness, trauma or surgery in those with primary adrenal failure
symptoms of addisonian crisis?
shock
weakness
reduced GCS
hypoglycaemia
