secondary adrenal insufficiency Flashcards
what is secondary adrenal insufficiency?
a failure to produce adequate steroids as a result of ACTH deficiency
causes of 2y?
pituitary disease
long term steroid use dampens down steroid axis
how does long term steroid use cause adrenal insufficiency?
dampens down steroid axis
when will dampening down of the steroid axis become apparent?
following withdrawal from the steroids
why would you not get dehydration in secondary ?
aldosterone is intact
would you get hyper pigmentation ?
no, ACTH levels would be low
investigation of secondary ?
short synacthen test
management of 2y?
hydrocortisone
two main causes of hyperaldosteronism?
idiopathic adrenal hyperplasia
conn’s syndrome (aldosterone secreting adrenal adenoma)
presentation of hyperaldosteronism?
polyuria polydypsia headaches weakness cramps (low sodium)
what would blood investigations for conns show
sodium high
potassium low
how do you diagnose conns?
plasma aldosterone:renin ratio >750
what is the saline suppression test?
failure to suppress aldosterone production by 50% following consumption of water
how do you identify an adrenal adenoma
CT abdomen
can also be found as an incidentaloma - a mass identified on CT with no clinical findings
treatment of conns?
lsproscopic adrenalaectomy
