What isa primary adrenal insufficiency?
Addison’s disease
What are the causes of Addison’s?
Autoimmune destruction Invasion Infiltartion Infection Infarction Iatrogenic
What test can be done to detect autoimmune Addison’s?
Adrenal antibodies to 21 hydroxylase
What are the common symptoms of Addison’s?
Weakness, fatigue, anorexia, weight loss Skin pigmentation Hy[otension Unexplained vomiting or diarrhoea Salt craving Postural symptoms
What are possible clues towards diagnosis of Addison’s?
Circulatory collapse, hypotension, dehydration
Hypoglycaemia
Hypothyroidism, body hair, amenorrhoea
Previous depression or weight loss
How is Addison’ diagnosed?
Routine bloods- U&E, glucose, FBC
Random cortisol
Synacthen test and basal ACTH
What random cortisol levels would exclude Addison’s?
> 700
When is a synacthen test done to diagnose Addison’s?
In acutely unwell patients, after starting steroid therapy
Wha is the treatment of Addison’s?
Glucocorticoid and mineralocorticoid replacement
What glucocorticoid replacement can be given to someone wth Addison’s?
Hydrocortisone
Prednisolone
Dexamethasone
How are glucocorticoids given in Addison’s?
In divided doses to mimic normal veriation
What mineralocorticoids can be given to treat addison’s?
Fludrocortisone
What factors are considered re dose when giving fludrocortisone in Addison’s?
Clinical status
U&E
Plasma renin level
What are the 3 self care rules for patients on steroids?
Never miss a dose
Double hydrocortisone in intercurrent illness
If severe diarrhoea/vomiting, call for help without delay
What can adrenal enzyme defects cause?
Congenital adrenal hyperplasia
What is the most common enzyme affected in congenital adrenal hyperplasia?
21 hydroxylase
What can severe cases of congenital adrenal hyperplasia cause?
Neonatal salt losing crisis
Ambiguous genitalia
What are the incomplete defects of congenital adrenal hyperplasia?
Pseudo-orecocious puberty in bys
Hirsutism in girls
What does hyper secretion from the adrenal cortex cause?
CUshing’s syndrome
Conn’s syndrome
What are the 2 types of Cushing’s?
ACTH dependent
ACTH independent
What are the causes of ACTH dependent Cushing’s?
Pituitary tumour= Cushing’s disease
Ectopic ACTH secretion e.g. lung carcinoid
What causes ACTH independent Cushing’s?
Adrenal tumour
What are the signs and symptoms of Cushing’s?
Central obesity Hypertension Glucose intolerance Hirsutism Amenorrhoea or impotency Purple striae Plethoric faces Bruise easily Osteoporosis Personality changes Acne Oedema Headache Poor wound healing
What is the most common cause of Cushing’s?
Cushing’s disease- pituitary tumour
What causes Conn’s syndrome?
Adenoma or bilateral hyperplasia
What is the pathology of Conn’s?
Increased angiotensin increases aldosterone and decreases renin
What is the effect of Conn’s syndrome?
Increased blood volume, BP and K+
How is Conn’s syndrome diagnosed?
Plasma aldosterone/plasma renin activity >20
What does hyper secretion from the adrenal medulla cause?
Pheochromocytoma
What does pheochromocytoma cause?
Hypersecretion of catecholamines
What are the signs and symptoms of pheochromocytoma?
Hypertension
Paroxysmal attacks- headaches, sweating, pal[itations, tremor, pallor, anxiety