adrenal insufficiency
Anatomy & Histology
CRH-ACTH
Mix
which one is the drug?
100
secondary adrenal insufficiency is caused by?
pituitary lesion, chronic steroid use
100
what does the adrenal medulla secrete?
adrenaline and noradrenaline
100
what hormones are involved in this axis and where are they released?
CRH: Hypothalamus
ACTH: anterior pituitary
Cortisol: Adrenal medulla
100
what does cortisol do?
control the body’s use of fats, proteins and carbohydrates; suppresses inflammation; regulates blood pressure; increases blood sugar; and can also decrease bone formation. controls the sleep/wake cycle
100
Sentret vs Septra
Septra (trimethoprim)
sentret :
200
secondary adrenal insufficiency is caused by a change to what hormone?
less ACTH
200
what are the three layers of the adrenal cortex?
zona glomerulosa, zona fasiculata, zona reticularis
200
How does chronic steroid use affect their CRH-ACTH
atrophies adrenal cortex → can’t produce cortisol → less cortisol can’t be replaced by adrenal gland
200
what are the symptoms of an adrenal crisis?
Abdominal pain or pain in your side (flank).
Long-lasting fatigue.
Loss of appetite.
Darker patches of skin (hyperpigmentation).
200
Axew vs. Azor
Azor (Olmesartan / Amlodipine)
Axew
300
what is an adrenal crisis and what problems does that cause?
cant produce cortisol in response to stress → goes into shock → fatality
300
what hormones are affected by primary and secondary adrenal insufficiency
- primary: aldosterone, ADH, androgens, cortisol
- secondary: cortisol, androgens
300
A young girl presents with her mother due to ambiguous genitalia that is causing them concern. After taking a history and several investigations, her doctor diagnoses her with congenital adrenal hyperplasia. Why is adrenal hyperplasia a feature of this condition?
inefficient cortisol synthesis
300
Gligar vs. Golett vs. Gleevec
Gleevec (imatinib)
Gligar:
Golett
400
what symptoms and signs are present in patients with secondary adrenal insufficiency but not in patients with Addison disease?
normal electrolyte levels, no hyperpigmentation, low ACTH
400
what hormones does the part labelled 6 and 7 secrete?
6: glucocorticoids, 7: androgens
400
A patient comes in complaining of tiredness, nausea and vomiting. you suspect adrenal insufficiency and order some tests. the results are below, what kind of adrenal insufficiency does the patient have?
morning cortisol: low, ACTH stimulation test: +ve, plasma aldosterone: no change, CRH: +v
tertiary
400
A patient presents to the clinic with low basal cortisol, high ACTH, hypokalemia, hyperpigmentation and anti 21-hydroxylase antibodies. What is the patient's likely diagnosis?
Adrenoleukodystrophy
Autoimmune primary adrenal insufficiency
Congenital adrenal hyperplasia
Secondary adrenal insufficiency
Autoimmune primary adrenal insufficiency
400
Rellor vs. rabsca vs. rozerem vs. rotom
Rozerem (melatonin)
Rellor:
Rabsca:
. Rotom:
500
What tests are conducted to confirm what type of adrenal insufficiency a patient has? what results would you expect for secondary adrenal insufficiency?
morning cortisol: low , ACTH stimulation test: positive , plasma aldosterone: no change, CRH stimulation test: negative
500
these are all pictures of different adrenal glands. what could cause the presentation of the glands at the top?
chronic corticosteroid use
500
how can you treat an adrenal crisis?
- low cortisol: IV hydrocortisone
- low aldosterone: IV fluids
- shock: vasodilators
500
what would be the levels of glucose, sodium and potassium in a patient with Addison's disease?
Glucose: low
Sodium: low
Potassium: high
500
Lokix vs. Luxio vs. Luxiq vs.
Klink vs. Uxie vs.
Tranquill
Luxiq (betamethasone)
bonus!
tranquill (benzodiazepine) but also:
Luxio: 
Lokix:
Klink:
Uxie: 