W7 Addison disease PDF Lecture Notes

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 13: Altered Hormonal and Metabolic Regulation Module 4: Clinical Models Dr. Romeo Batacan Jr. MPAT12001 Medical Pathoph...

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 13: Altered Hormonal and Metabolic Regulation Module 4: Clinical Models Dr. Romeo Batacan Jr. MPAT12001 Medical Pathophysiology Lecture Series Copyright © 2017 Wolters Kluwer Health | Lippincott Williams &Wilkins  Adrenal Cortical Hormone Insufficiency and AddisonDisease Pathophysiology Clinical manifestations Diagnostic criteria Treatment  Adrenal Cortical Hormone InsufficiencyPathophysiology Two forms of adrenal insufficiency: Primary: Addison disease – destruction of the layers adrenal gland cortex - rare cause of adrenal insufficiency Autoimmune destruction of the layers of the adrenal cortex Lack of secretion of hormones from cortex: adrenal gland cannot produce glucocorticoids, mineralocorticoids, or androgens Secondary/tertiary: disorders of HPA system – most common cause of adrenal insufficiency Lack of CRH or ACTH Destruction of pituitary gland (tumors, hemorrhage, trauma, radiation or surgical removal) Acute ACTH deficiency (acute adrenal crisis): one of the most serious endocrine disorders it can lead to severe hypotension, hypovolemic shock, and death Treatment with 5 S’s (salt, sugar, steroid, support, search for cause)  Adrenal Cortical Hormone Insufficiency 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 Darker pigmentation of skin (high ACTH) in Addison disease Distinguish primary and secondary forms of adrenal insufficiency Porth C. Pathophysiology : concepts of altered health states. 7th ed. Philadelphia, Lippincott Williams & Wilkins; 2005.  Adrenal Cortical Hormone Insufficiency DiagnosticCriteria History and physical examination Elevation of ACTH stimulate skin melanocytes ACTH chemical structure is similar to melanocyte stimulating hormone Hyperpigmentation, darkening of skin and mucous membranes Distinguish primary and secondary forms of adrenal insufficiency Laboratory test of electrolyte levels: Hyponatremia, hyperkalemia Serum corticosteroid levels remain depressed after administration of ACTH  Adrenal Cortical Hormone InsufficiencyTreatment In acute ACTH deficiency : IV fluid replacement with hydrocortisone gradual replacement of IV to oral therapy Pharmacologic treatment Lifelong administration Mineralocorticoid and glucocorticoid hormone properties During stress higher doses Dietary changes Regular schedule for meals and exercise Increased sodium intake due to excess sodium losses (sweating in hot weather)