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GENERAL MEDICINE > Endo- Addisons > Flashcards

Endo- Addisons Flashcards

1
Q

What are the two diseases associated with adrenal insufficiency

A
  1. Addison disease
  2. Waterhouse friderichsen syndrome
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2
Q

What is Waterhouse friderichsen syndrome

A

Acute primary adrenocortical insufficiency due to adrenal haemorrhage

There is a abrupt rise in blood pressure leads to rupture of blood vessel and collection of blood in adrenal gland and leads to ischemia of gland

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3
Q

What are the Associations of waterhouse friderichsen syndrome

A
  1. Neisseria meningitidis septicaemia
  2. DIC with widespread purpura
  3. hypotension leading to shock
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4
Q

What are the causes of primary adrenal insufficiency

A
  1. Malignancy
  2. infections (TB mostly)
  3. autoimmune disease (AIDS)
  4. Drugs (ketokonazole, pheniton, rifampin) 
  5. Bilateral adrenal haemorrhage  or infarction
  6. haemochromatosis
  7. Amyloidosis
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5
Q

What are the Causes of secondary Adrenal insufficiency

A
  1. Pituitary lesion (Tumour or trauma)
  2. Cessation of long term glucocorticoid therapy
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6
Q

What are the causes of adrenal crisis

A
  1. Infection
  2. trauma
  3. surgery
  4. abrupt discontinuation of glucocorticoid drugs 
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7
Q

How is adrenal crisis precipitated

A

Precipitated when a patient has a massive stress on their body But they aren’t able to produce in adequate amount of cortisol due to underlying chronic adrenal insufficiency

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8
Q

What are the symptoms of Addison’s disease

A
  1. Weakness
  2. Orthostatic hypotension
  3. Nausea, vomiting, diarrhea, anorexia and weight loss
  4. Skin pigmentation
  5. Hyperkalemia
  6. Hypoglycaemia
  7. Hyponatremia
  8. Metabolic acidosis
  9. Loss of hair in pubic and axillary area, libido
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9
Q

What’s the difference between primary vs. Secondary adrenal insufficiency

A

Secondary adrenal insufficiency has:
1. Decreased pituitary ACTH production
2. No skin hyperpigmentation
3. No hyperkalemia

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10
Q

What are the specific tests for adrenal insufficiency

A
  1. Short ACTH stimulation test or also known as short synacthen test
  2. Serum cortisol
  3. measurement of plasma ACTH
  4. anti-adrenal antibodies
  5. serum aldosterone
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11
Q

How much ACTH is administered in short ACTH stimulation test

A

250 µg ACTH by IM injection 

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12
Q

What results will be shown in short ACTH stimulation for normal patients and patients with adrenal insufficiency

A

Normal - cortisol increases above 500nm/l
Adrenal insufficiency- cortisol fails to increase (both secondary and primary)

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13
Q

How do you differentiate between primary and secondary adrenal insufficiency

A

Primary adrenal insufficiency- high ACTH
Secondary adrenal insufficiency - low ACTH

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14
Q

What is the treatment for primary adrenal insufficiency

A
  1. Glucocorticoid hydrocortisone
  2. mineral corticoid fludrocortisone
  3. Androgens
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15
Q

What is the treatment for secondary adrenal insufficienty

A

Only glucocorticoid no mineral corticoid is given because it is not ACTH dependent

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16
Q

How do you treat adrenal crisis

A
  1. IV resuscitation with normal saline
  2. IV hydrocortisone 100 mg stat. Then 100 MG 4 times a day for the first 12 to 24 hours
  3. IV 10% dextrose for hypoglycaemia
  4. NaCl for hyponatraemia
  5. Management of shock
  6. antibiotics
17
Q

In Addison’s disease there’s a deficiency of which adrenocortical Hormones

A
  1. Glucocorticoids
  2. mineralocorticoids
  3. adrenal androgens
18
Q

What are the generalized investigations for adrenal insufficiency

A
  1. Blood urea and serum electrolytes: urea, potassium, calcium and raised sodium decreased
  2. blood sugar: low
  3. blood CBC: neutropenia, lymphocytosis, eiosinophila
  4. x-ray chest: TB, fungal infection, cancer
  5. CT abdomen: shows small noncalcified adrenals in auto immune Addison’s disease, Enlarged Adrenals in metastatic disease calcified adrenals in TB.
19
Q

What is the generalized treatment for Addison’s disease

A
  1. Treat underlying cause
  2. Steroid replacement therapy
20
Q

What drugs are given for steroid therapy

A
  1. glucocorticoids: cortisol, prednisone, dexamethasone
  2. mineralocorticoids : fludrocortisone
  3. androgens: dehydroepiandrosterone
21
Q

What are the D/D’s for adrenal crisis

A
  1. Diabetic coma
  2. cerebrovascular accident
  3. acute poisoning
  4. other causes of confusion
  5. other causes of high-grade fever
22
Q

What are the complications during treatment for adrenal crisis

A
  1. Overhydration producing Pulmonary or cerebral oedema
    2. hypokalaemia producing flaccid paralysis
  2. generalized edema and hypertension

GENERAL MEDICINE (9 decks)

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