Adrenal Insufficiency Flashcards
What is it
When the adrenal glands fail to produce sufficient steroid hormone
Causes of primary adrenal insifficiency
Addisons disease
Idiopathic
Postadrenalectomy
Causes of Addisons disease
Metastases from breast, lung and renal cancers
Autoimmune
Infections
Lymphoma
Infections that can cause Addisons
TB is most common cause
Opportunistic infections e.g. Cytomegalovirus in HIV patients
Causes of secondary adrenal insufficiency
Prolonged prednisolone use
Pituitary adenoma
Sheehan’s syndrome
Signs and symptoms
Unintentional weight loss Myalgia Weakness Fatigue Postural hypotension Abdominal pain Skin pigmentation Body hair loss Diarrhoea N/V Depression
Which embryological layer forms the capsule (of kidneys and adrenal glands)
Mesoderm
Which part of embryological layers forms the adrenal medulla
Neural Crest
Diagnostic tests of adrenal insufficiency
Adrenocorticotrophic hormone and cortisol measurements
Insulin intolerance test
Short tetracosactide test
Other investigations of adrenal insufficiency, other than main diagnostic tests
Bloods
Radiology
What blood tests are taken
FBC U/Es (low sodium, high potassium) LFTs Glucose Lipid levels Serum calcium
What would you see on U/Es
Low sodium
High potassium
Radiology investigations
CXR - look for lung cancer
CT and MRI scan of the adrenal glands
Conservative treatment
Patient should be educated and should carry a steroid alert card
Medical treatment
Replace glucocorticoids and mineralocorticoids with hydrocortisone and fludrocortisone
Treat complications
