Please enable JavaScript.
Coggle requires JavaScript to display documents.
Adrenal Insufficienccy (Dx (METYRAPONE Stimualtion Test Which Blocks last…
Adrenal Insufficienccy
Hx
Weakness
Fatigue
GI Disturbances
Sugar / Salt CRAVING
Weight Loss
Dx
Serum ELECTROLYTES
Morning / Random Serum CORTISOL & ACTH
⬇ Cortisol & ⬆ ACTH in 1 Insufficiency
⬇ Cortisol & ACTH in 2/3 insufficincy
Response to ACTH Stimulation Test
METYRAPONE Stimualtion Test
Which Blocks last step of synthesis of Cortisol
Normal Response
⬇ Cortisol & ⬆ ACTH
In 1 Adrenal insufficiency
⬆ ACTh & ⬇ 11- Deoxycortisol
2/3 Adrenal Insufficiency
⬇ ACTH & 11- Deoxycortisol
1 Sufficiency
Type
Acute
Sudden Onset
Acute adrenal CRISIS + Shock
due to Massive Hemorrhage
WATERHOUSE Freidrichsen Syndrome
Due to Hemorrhage associated with SEPTICEMIA
N MENINGITIDIS
DIC & Endotoxic Shock
CHRONIC
ADDISON Disease
Due to
Adrenal Atrophy
Autoimmune Destruction ( MOST Common in WEST )
TB( Most Common in Developing World )
Hx
HYPOTENSION
HYponatremic Volume CONTRACTION
HYPERKALAMIA
METABOLIC ACIDOSIS
Skin & Mucosal HYPERPIGMENTATION
Due to ⬆ MSH ( Byproduct of ACTH Production from Propiomelanocortin )
2 Sufficiency
NO Hyperpigmentation
NO Hyperkalemia
Due to PRESERVED ALDOSTERONE Synthesis
Intact RAA Axis
3 Insufficiency
In Chronic Steroid USE
Precipitated by ABRUPT Withdrawal
Preserved Aldosterone