Internal Medicine

P1: SBT

0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18

70 Adrenal Insufficiency Adrenal Tumors

■Establish etiology of AI, treat associated conditions

■Educate patient to increase hydrocortisone during minor/major ill-

nesses, clinical alert bracelet

■Plasma ACTH may remain elevated despite appropriate replacement

therapy

complications and prognosis

■Adrenal crisis: development of acute AI when unable to take oral

medications or in setting of superimposed illness

■Cortisol excess: weight gain, Cushingoid features, metabolic syn-

drome

■Mineralocorticoid excess; edema, hypertension, hypokalemia

■With appropriate adrenocortical hormone replacement, lifespan

similar to healthy population

Adrenal Tumors......................................

RICHARD I. DORIN, MD

history & physical

History

■Abdominal mass

■TB or fungal infection

■Review of prior CT and MRI reports (note: most chest CT studies

include imaging of the adrenals)

■Adrenal “incidentaloma”

■History of malignancy, site and cell type of prior tumors

■Multiple endocrine neoplasia syndrome (MEN I and MEN II) and

related family history

■Abdominal/flank pain

■Menstrual history, skin and hair changes

■Hypertension, edema

■Weight gain, muscle weakness, polyuria

■Electrolyte abnormalities (esp. hypokalemia)

■Family history of adrenal tumors

■Osteoporosis, loss of height, bone fracture

■Medications: diuretics, glucocorticoids, oral contraceptives, proges-

tational agents

■Cigarette smoking

■Fluid/electrolyte loss: vomiting, diarrhea