ENDO Flashcards
What are the causes of adrenal insufficency
Primary adrenal insufficiency
•bilateral adrenal haemorrhage
- anticoagulants
- newborn
- severe sepsis (Freidrich-Waterhouse syndrome)
- Addison’s disease
- autoimmune diseases
- drugs
- suppression of adrenopituitary axis by steroid therapy
- ketoconazole
•infection
- tuberculosis
- protozoal
- viral – CMV, HSV, HIV
•malignancy
-primary adrenal
-secondary rarely causes insufficiency
-lung, lymphoma most commonly
- sarcoidosis
- iron deposition
- hereditary
Allgrove syndrome
- autosomal recessive
- features
- adrenal insufficiency due to ACTH resistance
- alacrima
- oesophageal achalasia
- present as children
- occasional neurological involvement
Secondary adrenal insufficiency
- pituitary failure
- hypothalamic
what are the precipitants for addiosns crisis
- Precipitating events
- major surgery
- AMI
- general anaesthesia
- hypoglycaemia
- major trauma
- hypothermia
- major psychiatric illness
- drugs
- morphine
- chlorpromazine
What are the clinical finding ?
In primary adrenal disease
- mucocutaneous pigmentation
- vitiligo
•BP < 100 mmHg with postural drop
-rarely is the systolic BP > 110 mmHg
What are the investigations finding in Addsions’s diseae
all routine laboratory investigations may be completely normal even in the presence of an Addisonian crisis
•hyponatraemia
- total body Na+ depletion
- intracellular movement
- Na+ < 120 mmol/L is rare
- hypochloraemia
- hyperkalaemia; due to
- acidosis causing movement of K+ from ICF to ECF
- aldosterone deficiency
- K+ rarely > 7 mmol/L
- mild hypercalcaemia in 10-20%
- non-anion gap metabolic acidosis
- hypoglycaemia
-usually mild
•if caused by adrenopituitary suppression
-little change in electrolytes as the renin - angiotensin - aldosterone axis remains intact
Antiphospholipid antibodies
- adrenal insufficiency is the first clinical manifestation of antiphospholipid antibody syndrome in up to 35% of patients
- consider screening for lupus anticoagulant and anticardiolipin antibody in all cases of adrenal haemorrhage and adrenal insufficiency of uncertain cause
what is the management of addsions crisis
Acute
•NaCl containing fluid replacement
-often many litres of total body fluid depleted
•adrenocorticoid replacement
- Dexamethasone 10 mg stat followed by 4 mg 6 hourly if the diagnosis is suspected but not confirmed
- does not interfere with subsequent cortisol assays
- hydrocortisone (250 mg stat then 100 mg 6 hourly) if the patient has known adrenal failure
- treat hypoglycaemia with 50 mL 50% dextrose
- other metabolic abnormalities are usually corrected with rehydration and mineralocorticoid replacement
•symptomatic hyperkalaemia may require treatment
•once the acute event has been managed, investigate the precipitating cause
