91
H N i Ti t
Map 5.9 Suy 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.
Bi n ch ng
•
Suy thư ng th n c p.
•
Tăng kali huy t.
•
H đư ng huy t
•
Tăng b ch c u ái toan.
•
Ch ng r ng tóc.
•
B nh Addison liên quan t i các b nh lý khác như:
○
Thi u máu ác tính.
○
Suy bu ng tr ng nguyên phát.
○
H i ch ng t mi n đa tuy n.
○
Basedow.
○
Viêm giáp Hashimoto.
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 The Hypothalamic–Pituitary–Adrenal Axis
Pituitary gland
ACTH
Adrenal cortex
Cortisol
Functions: 3
A
s
1
A
– m
A
ke glucose in the liver
2
A
–
A
ntistress pathway
3
A
–
A
nti-inflammatory pathway
Destruction of the adrenal cortex
leads to cortisol deficiency
MAP 5.9 Adrenal Insufficiency
•
Prolonged prednisolone use.
•
Pituitary adenoma.
•
Sheehan’s syndrome.
Secondary
FIGURE 5.3 Gi i ph u l p v và t y tuy n
thư ng th n
Lá trung bì
V
Mào th n
kinh
T y
L p c u
Aldosterone
L p bó
Cortisol
L p lư i
Androgens
Adrenaline
Noradrenaline
•
Skin pigmentation.
•
Body hair loss.
•
Diarrhoea.
•
Nausea.
•
Vomiting.
•
Depression.
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