Adrenal insufficiency
Endocrine MRCEM syllabus EnP1/EnC1
| Addisonian crisis is the 'acute on chronic' - but crisis may be first presentation | |
|---|---|
| Etiology | 80% - autoimmune reaction against cortex |
| Epidemiology | |
| Clinical presentation | Mineralocorticoid deficiency: ↓ Na, ↑ K, ↑ Ca Glucocorticoid deficiency: ↓ gluconeogenesis = hypoglycaemia Melanin pigmentation - ACTH++ accompanied by MSH Addisonian crisis: shock (fluid refractory hypotension), acute abdomen, generally unwell, hypoglycaemia |
| Pathogenesis | Extracellular fluid ↓ = shock ↓ Aldosterone - mineralocorticoid effects |
| Investigations | Short synacthen test 9am cortisol Paired cortisol and ACTH ? |
| Management | Adults - Hydrocortisone 100mg stat then 200mg over 24h (50mg QDS is the local fav) Children - 50mg hydrocortisone/m2 (usually 25mg in infants and 50mg in children) followed by 50mg/24h in infants and 100mg/24h in children. |
precipitants for Addisonian crisis
with no known pathology
- Pituitary infarction
- Bilateral adrenal haemorrhage
- Pituitary apoplexy
- Sheehan’s syndrome
- Sudden withdrawal of exogenous steroid