Flashcards in Adrenal - Insufficiency Deck (33)
In Addison's disease there is deficiency of which hormones?
Glucocorticoids and mineralocorticoids
80% of cases of Addison's disease in the UK are due to what?
What is the commonest cause of Addison's disease worldwide?
What is the commonest form of congenital adrenal hyperplasia and how is it inherited?
21 alpha hydroxylase deficiency - autosomal recessive
How does congenital adrenal hyperplasia present in boys?
Adrenal insufficiency and poor weight gain
How does congenital adrenal hyperplasia present in girls?
How is congenital adrenal hyperplasia treated?
Glucocorticoid and mineralocorticoid replacement
Describe a typical individual affected by Addison's disease?
Tall, thin, tanned, tired
What causes the hyperpigmentation that can be seen in Addison's disease?
What other autoimmune condition is commonly related to Addison's disease?
Addison's disease should be considered as a diagnosis in all individuals with which unexplained symptoms?
Abdominal pain or vomiting
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
What happens to the levels of sodium and potassium in Addison's disease?
Hyponatraemia and hyperkalaemia
If an acid-base disorder is to be seen in those with Addison's disease, what is it most likely to be?
What happens to blood glucose levels in Addison's disease?
What happens to the levels of renin and aldosterone in Addison's disease?
High renin, low aldosterone
What is the definitive investigation for diagnosing Addison's disease?
Short Synacthen test
Addison's disease can be excluded if the plasma cortisol is greater than what, 30 minutes after receiving IM synthetic ACTH?
Cortisol levels may be falsely elevated in who?
Pregnant women or those taking the COCP
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
What happens to the 9am ACTH level in primary adrenal insufficiency (i.e. Addison's disease)?
What happens to the 9am cortisol level in secondary adrenal insufficiency?
A 9am plasma cortisol level of what is highly suggestive of Addison's disease?
What is the treatment for Addison's disease?
Hydrocortisone (15-20mg PO) and fludrocortisone (50-200mcg PO)
How should hydrocortisone be given in the management of Addison's disease?
In 2-3 divided daily doses
What should patients with Addison's disease do before undertaking any strenuous exercise?
Take 5-10mg hydrocortisone
What should happen to the steroid doses in Addison's disease during an acute febrile illness?
Double the dose of hydrocortisone
How should an Addisonian crisis be treated immediately?
100mg IV hydrocortisone and IV fluid bolus
Patients in an Addisonian crisis may have what elecrolyte abnormality? What initial investigation should be done to check for this?
Hyperkalaemia - ECG