MEDI7111 Lecture Notes - Lecture 7: Polycythemia, Bleeding, Fludrocortisone
Endocrine 7
Adrenal Hyposecretion Disorders
Adrenal Insufficiency
There are many causes of primary adrenal insufficiency (e.g. random genetic disorders) with
the most common cause being autoimmune adrenalitis. Secondary adrenal insufficiency is
almost always iatrogenic from chronic steroid use, pituitary surgery, bilateral adrenalectomy,
Sheehan’s syndrome or apoplexy.
Clinical Features
GI disturbances
Hyperpigmentation of palms
Aldosterone Deficiency
oHyponatremia/hyperkalaemia
oAbdo pain/nausea/vomiting
oSalt craving
oserum creatinine (due to volume depletion) ↑
Cortisol Deficiency
oFatigue
oWeight loss
oAnorexia
oMyalgia/arthralgia
oFever
oNormochromic anaemia
oHypovolaemia/hypotension/postural hypotension
oHypoglycaemia
Androgen Deficiency
oIn women only
body hair ↓
Dry, itchy skin
libido ↓
Diagnosis
Diagnosis of adrenal insufficiency is made by a short synacthen test (synacthen is synthetic
ACTH). Blood cortisol is measured at time 0, 30 mins and 60 minutes after the administration of
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Document Summary
There are many causes of primary adrenal insufficiency (e. g. random genetic disorders) with the most common cause being autoimmune adrenalitis. Secondary adrenal insufficiency is almost always iatrogenic from chronic steroid use, pituitary surgery, bilateral adrenalectomy, Aldosterone deficiency: hyponatremia/hyperkalaemia, abdo pain/nausea/vomiting, salt craving o serum creatinine (due to volume depletion) Cortisol deficiency: fatigue, weight loss, anorexia, myalgia/arthralgia, fever, normochromic anaemia, hypovolaemia/hypotension/postural hypotension, hypoglycaemia. Androgen deficiency: in women only body hair. Diagnosis of adrenal insufficiency is made by a short synacthen test (synacthen is synthetic. Blood cortisol is measured at time 0, 30 mins and 60 minutes after the administration of synacthen. In normal individuals this causes secretion of cortisol from the adrenal glands within an hour however in patients with adrenal insufficiency, there will be negligible increase in cortisol production. Further investigation to localise the abnormality on the hpa axis may be required to localise the pathology.
