If you have secondary adrenal insufficiency, where is the problem?
pituitary gland
when does cortisol peak?
around 5-7 a.m. (about an hour before you get up)
lowest in the late afternoon
what is primary adrenal insufficiency?
Addison’s disease -
cortical problem in adrenal gland that knocks out production
what is the most common cause of Addison’s disease worldwide?
TB
(fungal infection - histoplasmosis, cryptococcus, CMV)
how much of the adrenal cortex must you lose in both glands to have adrenal insufficiency?
90%
what is the most common cause of Addison’s disease in the US?
autoimmune
what are the symptoms in chronic primary adrenal insufficiency?
weakness
tiredness
fatigue
anorexia
GI symptoms
salt craving
postural diziness
joint pain
what are the electrolyte disturbances in primary AI?
hyponatremia
hyperkalemia
what are some other laboratory findings in primary AI you might see?
- Anemia
- chronic disease - mild
- pernicious anemia
- volume loss
- eosinophilia
- elevated TSH (glucocorticoids suppress TSH)
what is the treatment of primary adrenal insufficiency?
glucocorticoids (prednisone or hydrocortisone)
+
mineralocorticoids (fludrocortisone)
*make sure that patients have a medic alert bracelet
in secondary AI, what don’t you have?
dehydration and hyperkalemia
what is more common in 2ndary adrenal insufficency?
hypoglycemia
WHY: no dehydration, patients tolerate AI longer and present with symptoms of glucorticoid deficiency and not mineralcorticoid deficiency
where is aldosterone made in the adrenals?
zona glomerulosa
how do we screen people for primary aldosteronism?
measure aldosterone to renin ratio
what percentage of people over 60 have an incidental nodule on the adrenal?
“incidentaloma”
6-8%
what do you do as treatment if there is aldosteronism unilaterally?
surgically remove the affected adrenal