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Endocrinology (Adrenals (Cushings (Cushing's syndrome inappropriately…

- - - - Sx: Glucocorticoid - hypoglycaemia, tiredness, weakness, nausea + vomiting (consider in all with abdo pain and vomiting); Mineralcorticoids - hyponatraemia, hypotension + hyperkalameia; DHEA (androgen) - loss of axillary/pubic hair; High ACTH (if primary) - hyper pigmentation
        
        Ix: Short ACTH Stimulation Test (Synacthen Test) - stimulates ACTH release in healthy patients cortisol should rise if it doesn't = Addisons
        
        Mx: Glucocorticoid replacement - Hydrocortisone; Mineralocortocoid replacement - Fludrocortisone; Sick day rules - double hydrocortisone in illness or injury - as stress usually stimulates glucocorticoid release
        
        If Addisons + hypothyroidism - give hydrocortisone first as giving levy can trigger Addisonian crisis
      - Cause: Autoimmune, TB, malignant metastatic disease
    - - Cause: Irradiation, infiltration, tumour, Chronic glucocorticoid use - stopping suddenly triggers ADDISONIAN CRISIS --> hyponatraemic, hypotensive, hypoglycaemic + hyperkalaemic, collapse, shock, pyrexia --> Rx: IV fluids + IV HYDROCORTISONE 100mg STAT
- - - - Heart failure, liver failure, nephrotic syndrome
    - - Hypothyroidism, Primary polydipsia, SIADH
    - - Low urinary Na = dehydration, Stoma, D+V, burns
      - High urinary Na = Diuretics, Addison's