Addison Disease and Adrenal Insufficiency Management Flashcards

A set of vocabulary-style flashcards covering the definition, symptoms, diagnostic tests, and stress-dosing protocols for Addison disease and Addisonian crisis.

Addison disease

A condition known as primary adrenal insufficiency where the adrenal glands are unable to produce enough hormones due to causes such as infection, damage, or an autoimmune response.

Symptoms of Addison

hypotension

hypoglycemia

hyponatiremia

gastro symptom: nausea, vomitting diarhea

mood swings, mental confusion or loss of consciousnes

Hyperpigmentation in Addison's

Increased pigmentation of the skin, specifically seen around scars and bony areas.

inveatigation

ACT, cortisol , electrolytes, renin, anti-adrenal antobody, image exam (CT more obvious)

Synacthen tests

Tests that show the body's baseline level of cortisol production and its response to an increased need; Addison’s disease is indicated if the test shows a flat or reduced response.

ACTH stimulating test /Synacthen

An investigation that measures cortisol levels before and after a challenge injection of synthetic ACTH.

Hypoglycemia test

A diagnostic procedure measuring blood glucose and cortisol levels at intervals before and after the injection of insulin.

Addisonian crisis

A sudden, acute, and potentially life-threatening worsening of symptoms requiring an immediate hydrocortisol injection.

what kind of situation should give extra dose

stress, infection/fever/ vomiting diarrhorea, sever sudden illness or injury in response to physiological demands.

Fever dosing ($> 38^{\circ}C/100.4^{\circ}F$)

The patient should double their normal daily dose(s) of hydrocortisone.

Fever dosing ($> 39^{\circ}C/102.2^{\circ}F$)

The patient should triple their normal daily dose(s) of hydrocortisone.

Severe infection stress-dosing

An initial $100\,mg$ hydrocortisone injection IV followed by $50\,mg$ every $6$ hours until the condition stabilizes.

Emergency injection kit for severe illness or injury

A kit containing $100\,mg$ IM/SC hydrocortisone used for severe sudden illness, injury.

Major surgery with long recovery time perioperative protocol

Administration of $50\,mg$ hydrocortisone IV with induction. continue

$50\,mg$ every $8$ hours for the first $24$ hours postoperatively, then resume normal dosing over 2 to 3 days.

Moderate surgery perioperative protocol

Administration of $25\,mg$ hydrocortisone IV with induction, hydrocortisone 25mg IV -8-hourly for 24 hours. then return to normal oral dose.

Labour and vaginal birth protocol

$25\,mg$ hydrocortisone IV at the onset of labour then $6$-hourly until delivery, $100\,mg$ IV at the time of delivery. double oral dose for 24 to 48 hours after delivery

Invasive bowel procedure protocol (colonoscpy , barium enema)

Hospital admission overnight with IV fluids, $100\,mg$ hydrocortisone IV during purgative preparation and at induction, followed by $20\,mg$ oral hydrocortisone $8$-hourly.

20mg hydrocortisone oral 8-hourly when retrun to normal dose

Reason for secondary adrenal efficiency

Chronic corticosteroid therapy can suppress the hypothalamic-pituitary-adrenal axis, leading to secondary adrenal insufficiency.Adrenal insufficiency should be suspected in patients on long-term steroids presenting with fatigue, hypotension, and non-specific symptoms.

Difference between primary and secondary adrenal efficiency

• Secondary adrenal insufficiency from steroid suppression typically presents without the hyperpigmentation seen in primary adrenal insufficiency.

Non specific symptoms for Addison disease

Addison's disease commonly presents with non-specific symptoms including fatigue, weight loss, postural hypotension, and hyperpigmentation

Most common cause of primary adrenal insufficiency

Autoimmune adrenalitis is the most common cause of primary adrenal insufficiency and often occurs with other autoimmune conditions.