adrenal insufficiency

Question 1

what is adrenal insufficiency?

Answer 1

-where the adrenal glands do not produce enough steroid hormone particularly aldosterone or cortisol

Question 2

what triggers the kidneys to produce cortisol?

Answer 2

-the hypothalamus produces CRH which triggers the anterior pituitary to produce ACTH which triggers the adrenal glands to produce cortisol

Question 3

what are the three different types of adrenal insufficiency?

Answer 3

• Primary
• Secondary
• Tertiary

Question 4

what is primary adrenal insufficiency?

Answer 4

-when there is a problem with the adrenal glands themselves that results in the reduction in the secretion of cortisol and aldosterone

Question 5

what is the most common cause of primary adrenal insufficiency?

Answer 5

Autoimmune condition called Addison’s

Question 6

what is secondary adrenal insufficiency?

Answer 6

-when there is loss or damage to the pituitary gland resulting in a reduction in the secretion of ACTH , meaning that the adrenal glands cannot be stimulated to produce cortisol

Question 7

what is the most common cause of secondary adrenal insufficiency?

Answer 7

loss or damage to the pituitary gland due to:

• surgery
• tumour
• infection
• loss of blood flow
• radiotherapy

Question 8

what is tertiary adrenal insufficiency?

Answer 8

-when there is a lack of CRH production from the hypothalamus, meaning that the pituitary gland cannot be stimulated to produce ACTH and thus the adrenal glands are unable to be stimulated to produce cortisol

Question 9

what is the most common cause of tertiary adrenal insuffieciency?

Answer 9

-long term use of oral steroids

Question 10

what are some signs/ symptoms of adrenal insufficiency?

Answer 10

• fatigue
• nausea
• cramps
• abdominal pain
• reduced libido
• hyperkalaemia
• hyponatraemia
• hyperpigmintation
• hypotension

Question 11

True/False

Addison’s can cause polydipsia and polyuria?

Answer 11

True

Question 12

what tests are usually done for patients with suspected addisons?

Answer 12

short synacthen test (ACTH stimulation test)= definitive

• hyponotraemia
• hyperkalaemia
• hypoglycaemia
• decreased cortisol/ aldosterone
• increased ACTH levels
• 21 hydroxylase antibodies

Question 13

how would ACTH levels differ in primary and secondary adrenal insufficiency?

Answer 13

primary= high ACTH

secondary=low ACTH

Question 14

what antibodies are present in Addison’s disease?

Answer 14

adrenal cortex antibodies

21-hydroxylase-antibodies

Question 15

what is done in a short synacthen test?

Answer 15

• performed in the morning
• test involves giving synacthen (wynthetic ACTH)
• the blood cortisol levels are measured at baseline, 30 mins and 60 mins after administration
• the synthetic ACTH will stimulate healthy adrenal glands to produce cortisol and the cortisol levels should at least double
• a failure for cortisol to rise/ if it is less than double of baseline indicates Addison’s disease (primary adrenal insufficiency)

Question 16

what is the treatment for adrenal insufficiency?

Answer 16

• hydrocortisone to replace cortisol

- fludrocortisone to replace aldosterone