89
H N i Ti t
Figure 5.2 T
r c dư i đ i-tuy n yên-tuy n thư ng th n
Treatment
•
Conservative: patient
education. Patient must
carry a steroid alert card.
•
Medical: replace glucocorticoids
and mineralocorticoids with
hydrocortisone and
fludrocortisone; treat
complications.
•
Surgery: surgical excision of
tumour, if indicated.
Complications
•
Adrenal crisis.
•
Hyperkalaemia.
•
Hypoglycaemia.
•
Eosinophilia.
•
Alopecia.
•
Addison’s disease is associated with other conditions such as
3PGH:
○
Pernicious anaemia.
○
Primary ovarian failure.
○
Polyglandular syndrome.
○
Graves’ disease.
○
Hashimoto’s thyroiditis.
Investigations
•
Diagnostic tests:
○
Adrenocorticotrophic
hormone (ACTH) and cortisol
measurements.
○
Insulin tolerance test.
○
Short tetracosactide test aka
Short Synacthen test.
•
Bloods: FBC, U&Es (¯ Na
+
, - K
+
),
LFTs, glucose, lipid levels, serum
calcium.
•
Radiology:
○
CXR (look for lung cancer).
○
CT and MRI scan of the
adrenal glands.
Signs and symptoms
•
Unintentional weight loss.
•
Myalgia.
•
Weakness.
•
Fatigue.
•
Postural hypotension.
•
Abdominal pain.
What is adrenal insufficiency?
This occurs when the adrenal glands fail to produce sufficient
steroid hormone. The causes of adrenal insufficiency may be
categorised into primary and secondary adrenal failure.
Type
Cause
Primary
Causes
•
Addison’s disease; causes: MAIL:
○
Metastases from breast, lung and renal cancers.
○
Autoimmune.
○
Infections, e.g. tuberculosis (commonest
cause) and opportunistic infections, such
as cytomegalovirus (CMV) in HIV patients.
○
Lymphomas.
•
Idiopathic.
•
Postadrenalectomy.
FIGURE 5.2 Tr c dư i đ i-tuy n yên-tuy n thư ng th n
T
uy n yên
ACTH
V
thư ng th n
Cortisol
C
h c năng
:
1 – Tân t o glucose gan
2 – Ch ng stress
3 – Ch ng viêm
Phá h y v thư ng th n d n
đ n thi u h t cortisol
MAP 5.9 Adrenal Insufficiency
•
Prolonged prednisolone use.
•
Pituitary adenoma.
•
Sheehan’s syndrome.
Secondary
FIGURE 5.3 Anatomy of the Adrenal Cortex and
Adrenal Medulla
Mesoderm
Capsule
Neural crest
Medulla
Zona glomerulosa
Aldosterone
Zona fascicularis
Cortisol
Zona reticularis
Androgens
Adrenaline
Noradrenaline
•
Skin pigmentation.
•
Body hair loss.
•
Diarrhoea.
•
Nausea.
•
Vomiting.
•
Depression.
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