0071643192.pdf

■ 2 °adrenal insufficiency from pituitary dysfunction; causes include:

■ Suppression from prolonged steroid use

■ Pituitary tumor or infarction

■ Basilar skull fracture

■ Infiltrative disease like sarcoidosis

■ Infection

■ Internal carotid artery aneurysm

Addison Disease

SYMPTOMS

■ Weakness and fatigue
■ Abdominal pain, nausea/vomiting, and anorexia
■ Syncope

SIGNS

■ Dehydration and shock
■ Hypoglycemia
■ Postural hypotension
■ Inaudible heart sounds
■ There is brownish pigmentation of the skin, particularly on pressure
points and hand creases. Increased pigmentation is seen with primary
adrenal insufficiency (in which ACTH and related peptides are elevated)
but not secondary adrenal insufficiency.
■ Electrolyte abnormalities: ↓Na+,↑K+, and ↑Ca^2 +
■ Azotemia
■ ECG changes
■ Hyperkalemia: Tall T, long PR and QT, and absent P waves
■ Low voltage
■ Inverted T waves and a depressed ST segment

TREATMENT

■ Glucocorticoid replacement: Hydrocortisone or prednisone
■ Mineralocorticoid replacement: Fludrocortisone acetate
■ Androgen replacement: Fluoxymesterone

Adrenal Crisis

DIAGNOSIS

■ Adrenal crisis presents with more extreme findings than adrenal insuffi-
ciency. Patients are usually very ill and near cardiovascular collapse. Refrac-
tory hypotension and hypoglycemia are extremely common.
■ Diagnosis is made with a cosyntropin stimulation test, which evaluates the
ability of the adrenals to release cortisol in response to the administration
of synthetic ACTH. Hydrocortisone interferes with the cortisol stimulation
test, but dexamethasone does not.

TREATMENT

■ IV fluids
■ Glucose if hypoglycemic

ENDOCRINE, METABOLIC, FLUID, AND

ELECTROLYTE DISORDERS

The endogenous

mineralocorticoid, aldosterone,

maintains volume by

stimulating renal sodium

reabsorption. In adrenal

insufficiency, the BP is low and

the sodium is low.