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Flashcards in FN: Adrenal Insufficiency Deck (19):
1

Primary Adrenal insufficiency

Addison's

2

Addisons disease

Destruction of adrenal cortex --> glucocorticoid and mineralcorticoid deficiency

3

Causes of Addisins

1. Autoimmune destruction: 80% in the UK
2. TB: commonest worldwide
3. Metastasis: lung, breast, kidneys
4. Haemorrhage: waterhouse-Friedrichson
5. Congenital

4

Symptoms of adrenal insufficiency

1. Wt. loss + anorexia
2. n/v, abdo pain, diarrhoea/constipation
3. Lethargy, depression
4. Hyperpigmentation: buccal mucosa, palmer creases
5. Postura hypotension --> dizziness, faints
6. Hypoglycaemia
7. Vitiligo
8.Addisonian crisis

5

Investigations

Bloods
Differential
Other

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Bloods show

Hyponatraemia/ Hyperkalaemia
REduce glucose
Reduced Caclium
Anaemia

7

Differential by using which tests

Short synACTHen test

8

SynACTH test

Cortisol before and after tetracosactide
Exclude Addison's if raised cortisol

if 9am ACTH (usually low)

9

Other investigations

1. 21-hydroxylase Abs: _ve in 80% of AI disease
2. Plasma renin and aldosterone
3. CXR: evidence of TB
4. AXR: adrenal calcification

10

Treatment

1. Replace
2. Advice
3. Follow up

11

Repace

Hydrocortisone
Fludrocortison

12

Advice

1. Dont stop steroids suddenly
2. Increase steroids during intercurrent illness, injury
3. Wear a medic-alert bracelet

13

Secondary adrenal insufficiency

i.e. hypothalamus or pituitary failure

14

Causes of secondary adrenal insufficiency

1. Chronic steroid use --> supression of HPA axis
2. Pituitary apoplexy/Sheehans
3. Pituitary microadenoma

15

Features of secondary adrenal insufficiency

1. Normal mineralcorticoid production
2. No pigmentation (ACTH drop)

16

Features of secondary adrenal insufficiency

1. Normal mineralcorticoid production
2. No pigmentation (ACTH drop)

17

Addisonian crisis presentation

Shocked: raised HR, postural drop, confused
Hypoglycaemia
Usually known addisons or chronic steroid use

18

Addisonian crisis precipitants

Infection
Trauma
Surgery
Stopping long-term steroids

19

Addisonian crisis management

1. Bloods: cortisol, ACTH, U+E, culture
2. Check CBG: glucose may be needed
3. Hydrocortisone 100mg IV 6hrly
4. IV crystalloid
5. Septic screen
6. Treat underlying cause

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