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Flashcards in Adrenal - Insufficiency Deck (33)
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1

In Addison's disease there is deficiency of which hormones?

Glucocorticoids and mineralocorticoids

2

80% of cases of Addison's disease in the UK are due to what?

Autoimmunity

3

What is the commonest cause of Addison's disease worldwide?

TB

4

What is the commonest form of congenital adrenal hyperplasia and how is it inherited?

21 alpha hydroxylase deficiency - autosomal recessive

5

How does congenital adrenal hyperplasia present in boys?

Adrenal insufficiency and poor weight gain

6

How does congenital adrenal hyperplasia present in girls?

Ambiguous genitalia

7

How is congenital adrenal hyperplasia treated?

Glucocorticoid and mineralocorticoid replacement

8

Describe a typical individual affected by Addison's disease?

Tall, thin, tanned, tired

9

What causes the hyperpigmentation that can be seen in Addison's disease?

Raised ACTH

10

What other autoimmune condition is commonly related to Addison's disease?

Vitiligo

11

Addison's disease should be considered as a diagnosis in all individuals with which unexplained symptoms?

Abdominal pain or vomiting

12

What are the most common causes of an Addisonian crisis?

Acute illness in those with pre-existing or undiagnosed Addison's disease / sudden stopping of long-term steroid medication

13

What happens to the levels of sodium and potassium in Addison's disease?

Hyponatraemia and hyperkalaemia

14

If an acid-base disorder is to be seen in those with Addison's disease, what is it most likely to be?

Metabolic acidosis

15

What happens to blood glucose levels in Addison's disease?

Hypoglycaemia

16

What happens to the levels of renin and aldosterone in Addison's disease?

High renin, low aldosterone

17

What is the definitive investigation for diagnosing Addison's disease?

Short Synacthen test

18

Addison's disease can be excluded if the plasma cortisol is greater than what, 30 minutes after receiving IM synthetic ACTH?

550nmol/L

19

Cortisol levels may be falsely elevated in who?

Pregnant women or those taking the COCP

20

If the short Synacthen test cannot be readily accessed, what is the next best investigation to do for Addison's disease?

9am cortisol and ACTH levels

21

What happens to the 9am ACTH level in primary adrenal insufficiency (i.e. Addison's disease)?

Raised

22

What happens to the 9am cortisol level in secondary adrenal insufficiency?

Low

23

A 9am plasma cortisol level of what is highly suggestive of Addison's disease?

< 100nmol/L

24

What is the treatment for Addison's disease?

Hydrocortisone (15-20mg PO) and fludrocortisone (50-200mcg PO)

25

How should hydrocortisone be given in the management of Addison's disease?

In 2-3 divided daily doses

26

What should patients with Addison's disease do before undertaking any strenuous exercise?

Take 5-10mg hydrocortisone

27

What should happen to the steroid doses in Addison's disease during an acute febrile illness?

Double the dose of hydrocortisone

28

How should an Addisonian crisis be treated immediately?

100mg IV hydrocortisone and IV fluid bolus

29

Patients in an Addisonian crisis may have what elecrolyte abnormality? What initial investigation should be done to check for this?

Hyperkalaemia - ECG

30

What is the commonest cause of secondary adrenal insufficiency?

Iatrogenic long-term steroid use