Podcast
Questions and Answers
What is the primary cause of Addison's disease?
What is the primary cause of Addison's disease?
- Inadequate production of insulin
- Long-term steroid use
- Damage to the adrenal cortex (correct)
- Overactive pituitary gland
How prevalent is autoimmune Addison's disease in the UK?
How prevalent is autoimmune Addison's disease in the UK?
- 1 in 1,000
- 1 in 15,000
- 1 in 5,000
- 1 in 10,000 (correct)
What hormones are primarily affected in Addison's disease?
What hormones are primarily affected in Addison's disease?
- Cortisol and aldosterone (correct)
- Thyroxine and cortisol
- Insulin and glucagon
- Adrenaline and dopamine
What condition can cause secondary adrenal insufficiency?
What condition can cause secondary adrenal insufficiency?
What is a critical concern in a patient experiencing an Addisonian crisis?
What is a critical concern in a patient experiencing an Addisonian crisis?
What role does cortisol play in the body?
What role does cortisol play in the body?
Which symptom is most commonly associated with adrenal insufficiency?
Which symptom is most commonly associated with adrenal insufficiency?
How does the administration of steroids for an extended period affect cortisol production?
How does the administration of steroids for an extended period affect cortisol production?
Which of the following is least likely to cause adrenal insufficiency?
Which of the following is least likely to cause adrenal insufficiency?
What percentage of patients experience vomiting as a cause of adrenal insufficiency?
What percentage of patients experience vomiting as a cause of adrenal insufficiency?
Which function is primarily regulated by aldosterone?
Which function is primarily regulated by aldosterone?
Which of the following effects can steroid treatment for adrenal insufficiency have?
Which of the following effects can steroid treatment for adrenal insufficiency have?
What percentage of patients report severe fatigue or inadequate medication as a cause of adrenal insufficiency?
What percentage of patients report severe fatigue or inadequate medication as a cause of adrenal insufficiency?
Which of the following is NOT a possible trigger for acute exacerbation of adrenal insufficiency?
Which of the following is NOT a possible trigger for acute exacerbation of adrenal insufficiency?
What is the first step in managing an adrenal crisis symptomatically?
What is the first step in managing an adrenal crisis symptomatically?
Which intervention is specifically indicated for managing hypoglycaemia in cases of adrenal crisis?
Which intervention is specifically indicated for managing hypoglycaemia in cases of adrenal crisis?
In the context of potential acute exacerbation, surgical procedures can be categorized as what type of trigger?
In the context of potential acute exacerbation, surgical procedures can be categorized as what type of trigger?
When sudden cessation of steroid treatment occurs, what state may the body enter?
When sudden cessation of steroid treatment occurs, what state may the body enter?
Which of the following is a recommended action in response to an adrenal crisis during emergency care?
Which of the following is a recommended action in response to an adrenal crisis during emergency care?
What does the acronym ABC stand for in emergency management of adrenal insufficiency?
What does the acronym ABC stand for in emergency management of adrenal insufficiency?
Which medical emergency could potentially trigger acute exacerbation of adrenal insufficiency?
Which medical emergency could potentially trigger acute exacerbation of adrenal insufficiency?
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Study Notes
Overview of Adrenal Insufficiency/Addison’s Disease
- Adrenal insufficiency, commonly known as Addison’s disease, is a rare but treatable condition affecting the adrenal glands.
- The adrenal glands are located atop the kidneys and produce essential hormones: cortisol and aldosterone.
- Addison's disease occurs when damage to the adrenal cortex prevents sufficient production of these hormones.
Hormonal Functions
- Cortisol helps regulate blood pressure and immune responses.
- Aldosterone maintains electrolyte balance, influencing blood salt levels.
- Both hormones assist the body in responding to stress and balancing insulin's effects.
Symptoms and Clinical Features
- Hyperpigmentation and vitiligo are notable skin changes associated with adrenal insufficiency.
- Patients may experience severe fatigue, nausea, vomiting, and gastrointestinal issues during an acute crisis.
Incidence and Demographics
- Autoimmune Addison's disease is prevalent in approximately 1 in 10,000 individuals, with 8,400 diagnosed cases in the UK.
- Typically affects young to middle-aged populations.
Causes and Triggers
- Common triggers for exacerbations include:
- Infection
- Hypoglycemia
- Emotional or physical stress
- Trauma or surgery
- Sudden cessation of steroid treatment
- Symptoms can result from longstanding steroid use, which may impede the body's natural cortisol production.
Treatment Protocol
- Treatment often involves glucocorticoid therapy, specifically hydrocortisone, administered IV or IM during a crisis.
- High-dose corticosteroids (40 mg for over a week, 20 mg for 2 weeks, 5 mg for over 4 weeks) can inhibit the body's cortisol production, leading to a risk of adrenal crisis for up to a year post-discontinuation.
Management Strategies During Crisis
- Immediate assessment of airway, breathing, and circulation (ABC).
- Maintain SpO2 levels above 94%.
- Establish IV access and administer 100 mg hydrocortisone if indicated.
- Address hypoglycemia with IV glucose when necessary.
- Continuous ECG monitoring.
- Rapid transport to an emergency department is essential for further evaluation and treatment.
Understanding the Disease's Impact
- Adrenal insufficiency can lead to rapid deterioration of health and poses a potential fatal risk if not managed promptly.
- Early recognition and appropriate treatment are critical in preventing life-threatening complications.
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