Podcast
Questions and Answers
What is the primary cause of Addison disease?
What is the primary cause of Addison disease?
- Trauma to the adrenal glands
- Autoimmune destruction of adrenal gland cortex (correct)
- Destruction of the pituitary gland
- Lack of ACTH secretion
Which deficiency is associated with dehydration and hyponatremia?
Which deficiency is associated with dehydration and hyponatremia?
- Electrolyte deficiency
- Androgen deficiency
- Mineralocorticoid deficiency (correct)
- Glucocorticoid deficiency
What condition can lead to acute adrenal crisis?
What condition can lead to acute adrenal crisis?
- Acute ACTH deficiency (correct)
- Excessive electrolytes
- Chronic fatigue syndrome
- Autoimmune diseases
Which symptom is NOT typically associated with glucocorticoid deficiency?
Which symptom is NOT typically associated with glucocorticoid deficiency?
Which treatment method is part of the 5 S’s for adrenal crisis management?
Which treatment method is part of the 5 S’s for adrenal crisis management?
Which symptom is characteristic of androgen deficiency in women?
Which symptom is characteristic of androgen deficiency in women?
What leads to high levels of ACTH and darker pigmentation of skin in Addison disease?
What leads to high levels of ACTH and darker pigmentation of skin in Addison disease?
Which is the most common cause of adrenal insufficiency?
Which is the most common cause of adrenal insufficiency?
Flashcards
Adrenal Cortical Hormone Insufficiency
Adrenal Cortical Hormone Insufficiency
A condition where the adrenal cortex does not produce enough hormones, leading to significant health issues.
Addison Disease
Addison Disease
A primary adrenal insufficiency caused by autoimmune destruction of the adrenal cortex, leading to low glucocorticoids, mineralocorticoids, and androgens.
Secondary adrenal insufficiency
Secondary adrenal insufficiency
Adrenal insufficiency caused by disorders affecting the HPA axis, often due to lack of ACTH from the pituitary.
Acute adrenal crisis
Acute adrenal crisis
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5 S’s Treatment
5 S’s Treatment
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Glucocorticoid deficiency symptoms
Glucocorticoid deficiency symptoms
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Mineralocorticoid deficiency symptoms
Mineralocorticoid deficiency symptoms
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Androgen deficiency symptoms in women
Androgen deficiency symptoms in women
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Study Notes
Adrenal Cortical Hormone Insufficiency
- Two forms of adrenal insufficiency:
- Primary (Addison's disease): Destruction of adrenal cortex layers, rare. Autoimmune destruction is a cause. Adrenal gland cannot produce glucocorticoids, mineralocorticoids, androgens.
- Secondary/Tertiary: Disorders of the HPA system (most common). Lack of CRH or ACTH, destruction of the pituitary gland (tumors, hemorrhage, trauma, radiation, or surgical removal).
Pathophysiology
- Primary: Autoimmune destruction of the adrenal cortex layers is a key cause. The adrenal gland can no longer produce sufficient hormones.
- Secondary/Tertiary: The HPA (hypothalamic-pituitary-adrenal) axis is disrupted, often due to issues with the pituitary or hypothalamus. ACTH (adrenocorticotropic hormone) production is reduced or absent.
Clinical Manifestations
- Glucocorticoid deficiency: Hypoglycemia, weakness, poor stress response, fatigue, anorexia, nausea, vomiting, weight loss, personality changes.
- Mineralocorticoid deficiency: Dehydration, hyponatremia, hyperkalemia, hypotension, weakness, fatigue, shock.
- Androgen deficiency: Sparse axillary and pubic hair in women.
- Skin changes: Darker pigmentation of the skin (high ACTH), a characteristic feature in Addison's Disease.
Diagnostic Criteria
- History and physical examination: Elevated ACTH stimulating skin melanocytes (darkening of skin); ACTH chemical structure similar to melanocyte stimulating hormone
- Laboratory tests:Electrolyte levels (hyponatremia, hyperkalemia); serum corticosteroid levels remain depressed after ACTH administration.
Treatment
- Acute ACTH deficiency: IV fluid replacement with hydrocortisone; gradual IV to oral therapy transition.
- Pharmacologic treatment: Lifelong administration of mineralocorticoid and glucocorticoid hormones, including higher doses during stress.
- Dietary changes: Regular schedule for meals and exercise; increased sodium intake due to excess sodium losses (sweating in hot weather).
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