CoreLine.Org - Adrenal Insufficiency Overview Presentation

Introduction:
Symptoms of adrenal insufficiency depend upon the rate and extent of loss of adrenal function, whether mineralcorticoid production is preserved, and the degree of associated stress

The onset of adrenal insufficiency is usually gradual and may go undetected until an illness or stress precipitates Adrenal Crisis.

Overview:

Acute Adrenal Crisis

--Infectious or other stress
--B/L adrenal hemorrhage and infarction
--Pituitary apoplexy

Chronic Primary Adrenal Insufficiency

Secondary/Tertiary Adrenal Insufficiency

Acute Adrenal Insufficiency:
Can occur with:
Patient with Primary Adrenal Insufficiency and a
precipitating stress/infection (Addison’s disease)
After Acute B/l adrenal infarction or hemorrhage
Septic Shock- causing transient relative adrenal insufficiency

Predominant Manifestations:
--SHOCK (most common)
--N/V
--Abdominal Pain (cause is unknown)
--Weakness/fatigue
--Lethargy
--Fever
--Hypoglycemia

Patients with long-standing Primary Adrenal insufficiency who present in crisis may have Hyper-pigmented Skin (secondary to ACTH hypersecretion), Weight Loss, and Electrolyte abnormalities

The major hormonal factor precipitating Adrenal Crisis is mineralocorticoid deficiency, not glucocorticoid

The major clinical problem is Hypotension:

Therefore, patients in adrenal crisis who present with hypotension need mineralocorticoid supplementation, Not just glucocorticoid