Zusammenfassung der Ressource
Adrenal cortical insufficiency
- congenital adrenal hyperplasia
- the commonest non-iatrogenic
cause of not enough cortisol &
mineralocorticoid secretion
- primary ACI (Addison's disease)
- rare in children
- may result from
- an autoimmune process
- sometimes in assoc
w/ other autoimmune
endocrine disorders
- diabetes mellitus
- hypothyroidism
- hypoparathyroidism
- haemorrhage/infarction
- neonatal
- meningococcal
septicaemia
- X-linked
adrenoleucodystrophy
- rare neurodegen
metabolic disorder
- TB (now rare)
- secondary to
- hypopituitarism from
hypothalmic-pituitary
disease
- hypothalamic-pituitary-adrenal suppression
- ff long term corticosteroid therapy
- presentation
- infants
- acute presentation
- salt-losing crisis
- hypotension
- and/or hypoglycaemia
- dehydration ff a gastroenteritis-like illness
- child recovers until next episode
- older children
- chronic ill health
- pigmentation
- e.g. buccal
- salt-craving
- Diagnosis
- U&E
- low Na+
- high K+
- blood gas
- metabolic acidosis
- blood glucose
- hypoglycaemia
- low plasma cortisol
- high plasma [ACTH]
- except in hypopituitarism
- ACTH (Synacthen) test
- plasma [cortisol] remain low in
- primary adrenal failure
- long-standing
pituitary/hypothalamic
Addison's disease
- normal response exclude adrenal cortical insufficiency
- Mx
- adrenal crisis
- urgent Rx
needed
- iv saline w/
glucose
- iv
hydrocortisone
- all at risk of this should
wear a MedicAlert bracelet
- long-term replacement
- glucocorticoid &
mineralocorticoid
replacement
- increase glucocorticoid dose by
3x during illness or for an op
- teach pt to inject
im
hydrocortisone in
an emergency